Sample records for accountability hsea organization

  1. Dietary enzymatically treated Artemisia annua L. supplementation alleviates liver oxidative injury of broilers reared under high ambient temperature

    NASA Astrophysics Data System (ADS)

    Wan, Xiaoli; Zhang, Jingfei; He, Jintian; Bai, Kaiwen; Zhang, Lili; Wang, Tian

    2017-09-01

    Heat stress induced by high ambient temperature is a major concern in commercial broiler production. To evaluate the effects of dietary enzymatically treated Artemisia annua L. (EA) supplementation on growth performance and liver oxidative injury of broilers reared under heat stress, a total of 320 22-day-old male broilers were randomly allotted into five groups with eight replicates of eight birds each. Broilers in the control group were housed at 22 ± 1 °C and fed the basal diet. Broilers in the HS, HS-EA1, HS-EA2, and HS-EA3 groups were fed basal diet supplemented with 0, 0.75, 1.00, and 1.25 g/kg EA, respectively, and reared under cyclic high temperature (34 ± 1 °C for 8 h/day and 22 ± 1 °C for 16 h/day). Broilers fed EA diets had higher final body weight, average daily body weight gain, and average daily feed intake, as well as liver concentration of reduced glutathione, activities of antioxidant enzymes, abilities to inhibit hydroxyl radical and superoxide radical (HS-EA2 and HS-EA3), and lower liver concentrations of reactive oxygen metabolites, malondialdehyde, and protein carbonyl (HS-EA1, HS-EA2, and HS-EA3) than HS group ( P < 0.05). EA treatment downregulated the mRNA levels of heat shock proteins 70 and 90, upregulated the mRNA levels of nuclear factor erythroid 2-related factor 2 (HS-EA1, HS-EA2, and HS-EA3) and heme oxygenase 1 (HS-EA2 and HS-EA3) in liver of heat-treated broilers ( P < 0.05). In conclusion, EA alleviated heat stress-induced growth depression and liver oxidative injury in broilers, possibly through improving the antioxidant capacity and regulating the pertinent mRNA expression. The appropriate inclusion level of EA in broiler diet is 1.00-1.25 g/kg.

  2. Accountable care organizations and prostate cancer care.

    PubMed

    Hollenbeck, Brent K; Kaufman, Samuel R; Borza, Tudor; Yan, Phyllis; Herrel, Lindsey A; Miller, David C; Luckenbaugh, Amy N; Skolarus, Ted A; Shahinian, Vahakn B

    2017-11-01

    Accountable care organizations have the potential to increase the value of healthcare by improving population health and enhanced financial stewardship. How practice context modifies effects on a specialty-focused disease, such as prostate cancer care, has implications for their success. We performed a retrospective cohort study of newly diagnosed men with prostate cancer between 2012 and 2013 using national Medicare data. Practice affiliation (small single-specialty, large single-specialty, multispecialty groups) and accountable care organization alignment were measured at the patient level. Generalized linear multivariable models were fitted to derive adjusted rates of treatment and spending for the 12-month period after diagnosis according to accountable care organization alignment and practice affiliation. Of 15,640 patients with newly diagnosed prostate cancer, 1,100 (7.0%) were aligned with accountable care organizations. Patients in these organizations had similar use of curative treatment to those not in accountable care organizations (71.4% vs. 70.0%, respectively; p=0.33), which did not vary with practice affiliation (p=0.39). Adjusted spending was higher among patients in accountable care organizations ($20,916 vs. $19,773, p=0.03); however, this relationship was independent of the practice affiliation (p=0.90). Higher accountable care organization penetration within a practice was associated with increased spending (p<0.05) but not with treatment (p=0.87). Prostate cancer patients aligned with accountable care organizations had similar rates of treatment, but increased spending, in the year following diagnosis. These findings were similar across practice affiliations. Better specialist engagement by accountable care organizations may be necessary for them to alter practice patterns for specialty care.

  3. How "accountable" are accountable care organizations?

    PubMed

    Addicott, Rachael; Shortell, Stephen M

    2014-01-01

    The establishment of accountable care organizations (ACOs) in the Affordable Care Act (ACA) was intended to support both cost savings and high-quality care. However, a key challenge will be to ensure that governance and accountability mechanisms are sufficient to support those twin ambitions. This exploratory study considers how recently developed ACOs have established governance structures and accountability mechanisms, particularly focusing on attempts at collaborative accountability and shared governance arrangements. Four case studies of ACOs across the United States were undertaken, with data collected throughout 2012. These involved 34 semistructured interviews with ACO administrative and clinical leaders, observation of nine meetings, and a review of documentary materials from each ACO. We identified very few examples of physicians being held to account as a collective and therefore only limited evidence of collaborative accountability impacting on behavior change. However, ACO leaders do have many mechanisms available to stimulate change across physicians. The challenge is to determine governance structure(s) and accountability mechanisms that facilitate the most effective combination of approaches, measures, incentives, and sanctions to achieve the goals of more accountable care. Accountability structures and processes will need to be tailored to local membership composition, historical evolution, and current stage of development. There are also some common lessons to be drawn. Shared goals and incentives should be reflected through performance criteria. It is important to align measures and thresholds across payers to ensure ACOs are not unnecessarily burdened or compromised by reporting on different and potentially disjointed measures. Finally, emphasis needs to be placed on the importance of credible, transparent data. This exploratory study provides early evidence regarding how ACOs are establishing their governance and accountability arrangements and

  4. Accounting Procedures for Student Organizations.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento.

    This two-part handbook presents information on accounting procedures for student organizations, with a focus on the laws, policies, and procedures that affect student body organizations. Part 1 contains information about: (1) legal status of a school's student body organization; (2) principles governing student body finance; (3) administration of…

  5. Accountable Care Organizations and Population Health Organizations.

    PubMed

    Casalino, Lawrence P; Erb, Natalie; Joshi, Maulik S; Shortell, Stephen M

    2015-08-01

    Accountable care organizations (ACOs) and hospitals are investing in improving "population health," by which they nearly always mean the health of the "population" of patients "attributed" by Medicare, Medicaid, or private health insurers to their organizations. But population health can and should also mean "the health of the entire population in a geographic area." We present arguments for and against ACOs and hospitals investing in affecting the socioeconomic determinants of health to improve the health of the population in their geographic area, and we provide examples of ACOs and hospitals that are doing so in a limited way. These examples suggest that ACOs and hospitals can work with other organizations in their community to improve population health. We briefly present recent proposals for such coalitions and for how they could be financed to be sustainable. Copyright © 2015 by Duke University Press.

  6. Emergency Department Involvement in Accountable Care Organizations in Massachusetts: A Survey Study.

    PubMed

    Ali, Nissa J; McWilliams, J Michael; Epstein, Stephen K; Smulowitz, Peter B

    2017-11-01

    We assess Massachusetts emergency department (ED) involvement and internal ED constructs within accountable care organization contracts. An online survey was distributed to 70 Massachusetts ED directors. Questions attempted to assess involvement of EDs in accountable care organizations and the structures in place in EDs-from departmental resources to physician incentives-to help achieve accountable care organization goals of decreasing spending and improving quality. Of responding ED directors, 79% reported alignment between the ED and an accountable care organization. Almost all ED groups (88%) reported bearing no financial risk as a result of the accountable care organization contracts in which their organizations participated. Major obstacles to meeting accountable care organization objectives included care coordination challenges (62%) and lack of familiarity with accountable care organization goals (58%). The most common cost-reduction strategies included ED case management (85%) and information technology (61%). Limitations of this study include that information was self-reported by ED directors, a focus limited to Massachusetts, and a survey response rate of 47%. The ED directors perceived that the majority of physicians were not familiar with accountable care organization goals, many challenges remain in coordinating care for patients in the ED, and most EDs have no financial incentives tied to accountable care organizations. EDs in Massachusetts have begun to implement strategies aimed at reducing admissions, utilization, and overall cost, but these strategies are not widespread apart from case management, even in a state with heavy accountable care organization penetration. Our results suggest that Massachusetts EDs still lack clear directives and direct involvement in meeting accountable care organization goals. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  7. Accountable Care Organizations: how to dress for success.

    PubMed

    Hayen, Arthur P; van den Berg, Michael J; Meijboom, Bert R; Westert, Gert P

    2013-06-01

    Accountable Care Organizations (ACOs) need to reconsider their provider configuration and make it capable of managing clinical and financial risk. To that aim, their management must decide which medical procedures are done by the ACO itself, and which are contracted out to market providers. Making this decision requires a balanced treatment of market and firm organization, recognizing that each has properties that can turn into relative strengths. Such a balanced treatment is lacking in the ACO debate. Using the transaction cost theory, we provide such a balanced treatment of market and firm organization, and discuss implications for the design of ACOs and accountable care initiatives in general.

  8. Accountable care organizations: financial advantages of larger hospital organizations.

    PubMed

    Camargo, Rodrigo; Camargo, Thaisa; Deslich, Stacie; Paul, David P; Coustasse, Alberto

    2014-01-01

    Accountable care organizations (ACOs) are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of this study suggest that ACOs based in a larger hospital organization are more likely to meet Centers for Medicare and Medicaid Services criteria for formation because of financial and structural assets of those entities.

  9. Public health departments and accountable care organizations: finding common ground in population health.

    PubMed

    Ingram, Richard; Scutchfield, F Douglas; Costich, Julia F

    2015-05-01

    We examined areas of potential collaboration between accountable care organizations and public health agencies, as well as perceived barriers and facilitators. We interviewed 9 key informants on 4 topics: advantages of public health agency involvement in accountable care organizations; services public health agencies could provide; practical, cultural, and legal barriers to accountable care organization-public health agency involvement; and business models that facilitate accountable care organization-public health agency collaboration. Public health agencies could help accountable care organizations partner with community organizations and reach vulnerable patients, provide population-based services and surveillance data, and promote policies that improve member health. Barriers include accountable care organizations' need for short-term financial yield, limited public health agency technical and financial capacity, and the absence of a financial model.

  10. Creating Highly Reliable Accountable Care Organizations.

    PubMed

    Vogus, Timothy J; Singer, Sara J

    2016-12-01

    Accountable Care Organizations' (ACOs) pursuit of the triple aim of higher quality, lower cost, and improved population health has met with mixed results. To improve the design and implementation of ACOs we look to organizations that manage similarly complex, dynamic, and tightly coupled conditions while sustaining exceptional performance known as high-reliability organizations. We describe the key processes through which organizations achieve reliability, the leadership and organizational practices that enable it, and the role that professionals can play when charged with enacting it. Specifically, we present concrete practices and processes from health care organizations pursuing high-reliability and from early ACOs to illustrate how the triple aim may be met by cultivating mindful organizing, practicing reliability-enhancing leadership, and identifying and supporting reliability professionals. We conclude by proposing a set of research questions to advance the study of ACOs and high-reliability research. © The Author(s) 2016.

  11. Sustainable competitive advantage for accountable care organizations.

    PubMed

    Macfarlane, Michael Alex

    2014-01-01

    In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value.

  12. Public Health Departments and Accountable Care Organizations: Finding Common Ground in Population Health

    PubMed Central

    Ingram, Richard; Scutchfield, F. Douglas

    2015-01-01

    We examined areas of potential collaboration between accountable care organizations and public health agencies, as well as perceived barriers and facilitators. We interviewed 9 key informants on 4 topics: advantages of public health agency involvement in accountable care organizations; services public health agencies could provide; practical, cultural, and legal barriers to accountable care organization–public health agency involvement; and business models that facilitate accountable care organization–public health agency collaboration. Public health agencies could help accountable care organizations partner with community organizations and reach vulnerable patients, provide population-based services and surveillance data, and promote policies that improve member health. Barriers include accountable care organizations’ need for short-term financial yield, limited public health agency technical and financial capacity, and the absence of a financial model. PMID:25790392

  13. 76 FR 67801 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-02

    ... Community Care Network NP Nurse Practitioner NPI National Provider Identifier NQF National Quality Forum OIG...: Accountable Care Organizations; Final Rule #0;#0;Federal Register / Vol. 76 , No. 212 / Wednesday, November 2... Savings Program: Accountable Care Organizations AGENCY: Centers for Medicare & Medicaid Services (CMS...

  14. Accountable care organizations: impact on pharmacy.

    PubMed

    Amara, Shilpa; Adamson, Robert T; Lew, Indu; Slonim, Anthony

    2014-03-01

    The Patient Protection and Affordable Care Act (PPACA) has considerably transformed the approaches being used to deliver health care in the United States. It was enacted to expand health insurance access, improve funding for health professions education, and reform patient care delivery. The traditional fee-for-service payment system has been criticized for overspending and providing substandard quality of care. The Accountable Care Organization (ACO) was developed as a payment reform mechanism to slow rising health care costs and improve quality. Under this concept, networks of clinicians and hospitals share responsibility for a population of patients and are held accountable for the financial and clinical outcomes. Due to high rates of medication misuse, nonadherence to therapeutic medication regimens, and preventable adverse drug events, pharmacists are in an ideal position to manage drug therapy and reduce health care expenditures; as such, they may be valuable assets to the ACO team. This article discusses the role of the pharmacist in the era of ACOs specifically and health care reform globally. It outlines pharmacy-related quality of care measures, medication therapy management (MTM) programs (which may provide the foundation for pharmacist involvement in ACOs), and pharmacist functions in patient-centered medical homes (through which ACO services may be organized). The article concludes with a description of successful ACO models that have incorporated pharmacists into their programs.

  15. Accountable care organizations and radiology: threat or opportunity?

    PubMed

    Abramson, Richard G; Berger, Paul E; Brant-Zawadzki, Michael N

    2012-12-01

    Although the anticipated rise of accountable care organizations brings certain potential threats to radiologists, including direct threats to revenue and indirect systemic changes jeopardizing the bargaining leverage of radiology groups, accountable care organizations, and other integrated health care delivery models may provide radiology with an important opportunity to reassert its leadership and assume a more central role within health care systems. Capitalizing on this potential opportunity, however, will require radiology groups to abandon the traditional "film reader" mentality and engage actively in the design and implementation of nontraditional systems service lines aimed at adding differentiated value to larger health care organizations. Important interlinked and mutually reinforcing components of systems service lines, derived from radiology's core competencies, may include utilization management and decision support, IT leadership, quality and safety assurance, and operational enhancements to meet organizational goals. Such systems-oriented service products, tailored to the needs of individual integrated care entities and supported by objective performance metrics, may provide market differentiation to shield radiology from commoditization and could become an important source of new nonclinical revenue. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  16. Building regulatory and operational flexibility into accountable care organizations and 'shared savings'.

    PubMed

    Lieberman, Steven M; Bertko, John M

    2011-01-01

    The Affordable Care Act created accountable care organizations (ACOs), which will be a new part of Medicare as of January 2012, together with a "shared savings program" that will modify how these organizations will be paid to care for patients. Accountable care organizations have the potential to lower costs, improve the quality of care, facilitate delivery system reform, and promote innovation in health care. The federal government is set to create rules to regulate these organizations and has broad discretion to allow them to pursue a variety of approaches. Drawing on experience from some ACO pilot programs and the Medicare Part D prescription drug coverage program, we argue that regulations governing accountable care organizations should be flexible, encouraging of diversity and innovation and allowing for changes over time based on lessons learned. We recommend using regulations as a general framework, while relying on notices and other guidance below the regulatory level to spell out specific requirements.

  17. Oral Health Care Delivery Within the Accountable Care Organization.

    PubMed

    Blue, Christine; Riggs, Sheila

    2016-06-01

    The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

  18. Aligning for accountable care: Strategic practices for change in accountable care organizations.

    PubMed

    Hilligoss, Brian; Song, Paula H; McAlearney, Ann Scheck

    Alignment within accountable care organizations (ACOs) is crucial if these new entities are to achieve their lofty goals. However, the concept of alignment remains underexamined, and we know little about the work entailed in creating alignment. The aim of this study was to develop the concept of aligning by identifying and describing the strategic practices administrators use to align the structures, processes, and behaviors of their organizations and individual providers in pursuit of accountable care. We conducted 2-year qualitative case studies of four ACOs that have assumed full risk for the costs and quality of care for defined populations. Five strategic aligning practices were used by all four ACOs. Informing both aligns providers' understandings with the goals and value proposition of the ACO and aligns the providers' attention with the drivers of performance. Involving both aligns ACO leaders' understandings with the realities facing providers and aligns the policies of the ACO with the needs of providers. Enhancing both aligns the operations of individual provider practices with the operations of the ACO and aligns the trust of providers with the ACO. Motivating aligns what providers value with the goals of the ACO. Finally, evolving is a metapractice of learning and adapting that guides the execution of the other four practices. Our findings suggest that there are second-order cognitive (e.g., understandings and attention) and cultural (e.g., trust and values) levels of alignment, as well as a first-order operational level (organizational structures, processes, and incentives). A well-aligned organization may require ongoing repositioning at each of these levels, as well as attention to both cooperative and coordinative dimensions of alignment. Implications for research and practice are discussed.

  19. Accountable Care Organizations: The National Landscape.

    PubMed

    Shortell, Stephen M; Colla, Carrie H; Lewis, Valerie A; Fisher, Elliott; Kessell, Eric; Ramsay, Patricia

    2015-08-01

    There are now more than seven hundred accountable care organizations (ACOs) in the United States. This article describes some of their most salient characteristics including the number and types of contracts involved, organizational structures, the scope of services offered, care management capabilities, and the development of a three-category taxonomy that can be used to target technical assistance efforts and to examine performance. The current evidence on the performance of ACOs is reviewed. Since California has the largest number of ACOs (N=67) and a history of providing care under risk-bearing contracts, some additional assessments of quality and patient experience are made between California ACOs and non-ACO provider organizations. Six key issues likely to affect future ACO growth and development are discussed, and some potential "diagnostic" indicators for assessing the likelihood of potential antitrust violations are presented. Copyright © 2015 by Duke University Press.

  20. Accounting Procedures for Student Organizations. 1979 Edition. School Business Administration Publication No. 3.

    ERIC Educational Resources Information Center

    California Association of School Business Officials, Sacramento.

    This manual focuses attention on the problems involved in accounting for student body organization funds and offers information that may be used by school districts in establishing, reviewing, and revising fiscal policies and accounting procedures for student body organizations. It is intended that the application of the basic principles set forth…

  1. Accountable Care Organizations: what they mean for the country and for neurointerventionalists.

    PubMed

    Meehan, Timothy M; Harvey, H Benjamin; Duszak, Richard; Meyers, Philip M; McGinty, Geraldine; Nicola, Gregory N; Hirsch, Joshua A

    2016-06-01

    The Affordable Care Act is celebrating its fifth anniversary and remains one of the most significant attempts to reform healthcare in US history. Prior to the federal legislation, Accountable Care Organizations had largely been part of an academic discussion about how to control rising healthcare costs, but have since become a fixture in our national healthcare landscape. A fundamental shift is underway in the relationship between healthcare delivery and payment models. Some elements of Accountable Care Organizations may remain unfamiliar to most healthcare providers, including neurointerventional specialists. In this paper we review the fundamental concepts behind and the current forms of Accountable Care Organizations, and discuss the challenges and opportunities they present for neurointerventionalists. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Breast Imaging: A Paradigm for Accountable Care Organizations.

    PubMed

    Parikh, Jay R; Yang, Wei T

    2016-02-01

    Accountable care organizations (ACOs) are being promoted by the Centers of Medicare Services as alternative payment models for radiology reimbursement. Because of its clinical orientation, focus on prevention, standardized reporting, quality orientation through mandatory accreditation, and value demonstration through established outcome metrics, breast imaging offers a unique paradigm for the ACO model in radiology. In radiology, breast imaging represents the paradigm for ACOs.

  3. A Taxonomy of Accountable Care Organizations for Policy and Practice

    PubMed Central

    Shortell, Stephen M; Wu, Frances M; Lewis, Valerie A; Colla, Carrie H; Fisher, Elliott S

    2014-01-01

    Objective To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance. Data Sources/Study Setting Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs. Study Design Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data. Principal Findings We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital–physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities. Conclusions ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations. PMID:25251146

  4. A taxonomy of accountable care organizations for policy and practice.

    PubMed

    Shortell, Stephen M; Wu, Frances M; Lewis, Valerie A; Colla, Carrie H; Fisher, Elliott S

    2014-12-01

    To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance. Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs. Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data. We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital-physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities. ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations. © Health Research and Educational Trust.

  5. An ethical framework for the responsible leadership of accountable care organizations.

    PubMed

    McCullough, Laurence B

    2012-01-01

    Using the ethical concepts of co-fiduciary responsibility in patient care and of preventive ethics, this article provides an ethical framework to guide physician and lay leaders of accountable care organizations. The concept of co-fiduciary responsibility is based on the ethical concept of medicine as a profession, which was introduced into the history of medical ethics in the 18th century. Co-fiduciary responsibility applies to everyone who influences the processes of patient care: physicians, organizational leaders, patients, and patients' surrogates. A preventive ethics approach to co-fiduciary responsibility requires leaders of accountable care organizations to create organizational cultures of fiduciary professionalism that implement and support the following: improving quality based on candor and accountability, reasserting the physician's professional role in the informed consent process, and constraining patients' and surrogates' autonomy. Sustainable organizational cultures of fiduciary professionalism will require commitment of organizational resources and constant vigilance over the intellectual and moral integrity of organizational culture.

  6. Transforming healthcare delivery: Why and how accountable care organizations must evolve.

    PubMed

    Chen, Christopher T; Ackerly, D Clay; Gottlieb, Gary

    2016-09-01

    Accountable care organizations (ACOs) have shown promise in reducing healthcare spending growth, but have proven to be financially unsustainable for many healthcare organizations. Even ACOs with shared savings have experienced overall losses because the shared savings bonuses have not covered the costs of delivering population health. As physicians and former ACO leaders, we believe in the concept of accountable care, but ACOs need to evolve if they are to have a viable future. We propose the novel possibility of allowing ACOs to bill fee-for-service for their population health interventions, a concept we call population health billing. Journal of Hospital Medicine 2016;11:658-661. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  7. Accountable Care Organizations: roles and opportunities for hospitals.

    PubMed

    Schoenbaum, Stephen C

    2011-08-01

    Federal health reform has established Medicare Accountable Care Organizations (ACOs) as a new program, and some states and private payers have been independently developing ACO pilot projects. The objective is to hold provider groups accountable for the quality and cost of care to a population. The financial models for providers generally build off of shared savings between the payers and providers or some type of global payment that includes the possibility of partial or full capitation. For ACOs to achieve the same outcomes with lower costs or, better yet, improved outcomes with the same or lower costs, the delivery system will need to become more oriented toward primary care and care coordination than is currently the case. Providers of clinical services, in order to be more effective, efficient, and coordinated, will need to be supported by a variety of shared services, such as off-hours care, easy access to specialties, and information exchanges. These services can be organized by an ACO as a medical neighborhood or community. Hospitals, because they have a management structure, history of developing programs and services, and accessibility 24/7/365, are logical leaders of this enhancement of health care delivery for populations and other providers.

  8. Space Station Freedom Water Recovery test total organic carbon accountability

    NASA Technical Reports Server (NTRS)

    Davidson, Michael W.; Slivon, Laurence; Sheldon, Linda; Traweek, Mary

    1991-01-01

    Marshall Space Flight Center's (MSFC) Water Recovery Test (WRT) addresses the concept of integrated hygiene and potable reuse water recovery systems baselined for Space Station Freedom (SSF). To assess the adequacy of water recovery system designs and the conformance of reclaimed water quality to established specifications, MSFC has initiated an extensive water characterization program. MSFC's goal is to quantitatively account for a large percentage of organic compounds present in waste and reclaimed hygiene and potable waters from the WRT and in humidity condensate from Spacelab missions. The program is coordinated into Phase A and B. Phase A's focus is qualitative and semi-quantitative. Precise quantitative analyses are not emphasized. Phase B's focus centers on a near complete quantitative characterization of all water types. Technical approaches along with Phase A and partial Phase B investigations on the compositional analysis of Total Organic Carbon (TOC) Accountability are presented.

  9. Achieving Population Health in Accountable Care Organizations

    PubMed Central

    Walker, Deborah Klein

    2013-01-01

    Although “population health” is one of the Institute for Healthcare Improvement’s Triple Aim goals, its relationship to accountable care organizations (ACOs) remains ill-defined and lacks clarity as to how the clinical delivery system intersects with the public health system. Although defining population health as “panel” management seems to be the default definition, we called for a broader “community health” definition that could improve relationships between clinical delivery and public health systems and health outcomes for communities. We discussed this broader definition and offered recommendations for linking ACOs with the public health system toward improving health for patients and their communities. PMID:23678910

  10. The March to Accountable Care Organizations--How Will Rural Fare?

    ERIC Educational Resources Information Center

    MacKinney, A. Clinton; Mueller, Keith J.; McBride, Timothy D.

    2011-01-01

    Purpose: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). Methods: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA)…

  11. Analysis & commentary: The accountable care organization: whatever its growing pains, the concept is too vitally important to fail.

    PubMed

    Crosson, Francis J

    2011-07-01

    The success of health reform efforts will depend, in part, on creating new and better ways to organize, deliver, and pay for health care. Increasingly central to this idea is the accountable care organization model proposed for Medicare and a slightly different model for commercial health care. But these new health care delivery and payment models face considerable skepticism. Can Medicare succeed with accountable care organizations if physicians can't determine whether patients are in the organization or not? Will commercial hospitals use their clout to create accountable care organizations, leaving physician practices in a weaker position? This article answers those and other criticisms of the developing accountable care organization movement. If the concept fails, the nation may face indiscriminate cuts to health care payments, with resulting reductions in access, service, and quality.

  12. The Strategic Management of Accountability in Nonprofit Organizations: An Analytical Framework.

    ERIC Educational Resources Information Center

    Kearns, Kevin P.

    1994-01-01

    Offers a framework stressing the strategic and tactical choices facing nonprofit organizations and discusses policy and management implications. Claims framework is a useful tool for conducting accountability audits and conceptual foundation for discussions of public policy. (Author/JOW)

  13. Private sector accountable care organization development: a qualitative study.

    PubMed

    Scheck McAlearney, Ann; Hilligoss, Brian; Song, Paula H

    2017-03-01

    To explore accountable care organizations (ACOs) as they develop in the private sector, including their motivation for development, perspectives from consumers regarding these emerging ACOs, and the critical success factors associated with ACO development. Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers. Sixty-eight key informant interviews conducted during site visits, supplemented by document collection and telephone interviews, and 5 focus groups were held with 52 consumers associated with the study ACOs. We found 3 main motivators for private sector ACO development: 1) opportunity to improve quality and efficiency, 2) potential to improve population health, and 3) belief that payment reform is inevitable. With respect to consumer perspectives, consumers were unaware they received care from an ACO. From the perspectives of ACO stakeholders, these ACOs noted that they prefer to focus on patients' relationships with providers and typically do not emphasize the ACO name or entity. Critical success factors for private sector ACO development included provider engagement, strategic buy-in, prior experience managing risk, IT infrastructure, and leadership, all meant to shift the culture to a focus on value instead of volume. These organizations perceived that pursuing an accountable care strategy allowed them to respond to policy changes anticipated to impact the way healthcare is delivered and reimbursed. Increased understanding of factors that have been important for more mature private sector ACOs may help other healthcare organizations as they strive to enhance value and advance in their ACO journeys.

  14. Figure-ground organization and object recognition processes: an interactive account.

    PubMed

    Vecera, S P; O'Reilly, R C

    1998-04-01

    Traditional bottom-up models of visual processing assume that figure-ground organization precedes object recognition. This assumption seems logically necessary: How can object recognition occur before a region is labeled as figure? However, some behavioral studies find that familiar regions are more likely to be labeled figure than less familiar regions, a problematic finding for bottom-up models. An interactive account is proposed in which figure-ground processes receive top-down input from object representations in a hierarchical system. A graded, interactive computational model is presented that accounts for behavioral results in which familiarity effects are found. The interactive model offers an alternative conception of visual processing to bottom-up models.

  15. Pediatric Accountable Care Organizations: Insight From Early Adopters.

    PubMed

    Perrin, James M; Zimmerman, Edward; Hertz, Andrew; Johnson, Timothy; Merrill, Tom; Smith, David

    2017-02-01

    Partly in response to incentives in the Affordable Care Act, there has been major growth in accountable care organizations (ACO) in both the private and public sectors. For several reasons, growth of ACOs in pediatric care has been more modest than for older populations. The American Academy of Pediatrics collaborated with Leavitt Partners, LLC, to carry out a study of pediatric ACOs, including a series of 5 case studies of diverse pediatric models, a scan of Medicaid ACOs, and a summit of leaders in pediatric ACO development. These collaborative activities identified several issues in ACO formation and sustainability in pediatric settings and outlined a number of opportunities for the pediatric community in areas of organization, model change, and market dynamics; payment, financing, and contracting; quality and value; and use of new technologies. These insights can guide future work in pediatric ACO development. Copyright © 2017 by the American Academy of Pediatrics.

  16. Accountable Care Organizations and Transaction Cost Economics.

    PubMed

    Mick, Stephen S Farnsworth; Shay, Patrick D

    2016-12-01

    Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information "impactedness." Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development. © The Author(s) 2016.

  17. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey

    PubMed Central

    D’Aunno, Thomas; Friedmann, Peter D.; Chen, Qixuan; Wilson, Donna M.

    2016-01-01

    To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation’s fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors’ perceptions of market competition, organizational ownership, and geographic location are significantly related to SATinvolvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. PMID:26124307

  18. Accounting for microbial habitats in modeling soil organic matter dynamics

    NASA Astrophysics Data System (ADS)

    Chenu, Claire; Garnier, Patricia; Nunan, Naoise; Pot, Valérie; Raynaud, Xavier; Vieublé, Laure; Otten, Wilfred; Falconer, Ruth; Monga, Olivier

    2017-04-01

    The extreme heterogeneity of soils constituents, architecture and inhabitants at the microscopic scale is increasingly recognized. Microbial communities exist and are active in a complex 3-D physical framework of mineral and organic particles defining pores of various sizes, more or less inter-connected. This results in a frequent spatial disconnection between soil carbon, energy sources and the decomposer organisms and a variety of microhabitats that are more or less suitable for microbial growth and activity. However, current biogeochemical models account for C dynamics at the macroscale (cm, m) and consider time- and spatially averaged relationships between microbial activity and soil characteristics. Different modelling approaches have intended to account for this microscale heterogeneity, based either on considering aggregates as surrogates for microbial habitats, or pores. Innovative modelling approaches are based on an explicit representation of soil structure at the fine scale, i.e. at µm to mm scales: pore architecture and their saturation with water, localization of organic resources and of microorganisms. Three recent models are presented here, that describe the heterotrophic activity of either bacteria or fungi and are based upon different strategies to represent the complex soil pore system (Mosaic, LBios and µFun). These models allow to hierarchize factors of microbial activity in soil's heterogeneous architecture. Present limits of these approaches and challenges are presented, regarding the extensive information required on soils at the microscale and to up-scale microbial functioning from the pore to the core scale.

  19. Surgeon Participation in Early Accountable Care Organizations.

    PubMed

    Resnick, Matthew J; Graves, Amy J; Buntin, Melinda B; Richards, Michael R; Penson, David F

    2018-03-01

    We aimed to characterize the landscape of surgeon participation in early accountable care organizations (ACOs) and to identify specialty-, organization-, and market-specific factors associated with ACO participation. Despite rapid deployment of alternative payment models (APMs), little is known about the prevalence of surgeon participation, and key drivers behind surgeon participation in APMs. Using data from SK&A, a research firm, we evaluated the near universe of US practices to characterize ACO participation among 125,425 US surgeons in 2015. We fit multivariable logistic regression models to characterize key drivers of ACO participation, and more specifically, the interaction between ACO affiliation and organizational structure. Of 125,425 US surgeons, 27,956 (22.3%) participated in at least 1 ACO program in 2015. We observed heterogeneity in participation by subspecialty, with trauma and transplant reporting the highest rate of ACO enrollment (36% for both) and plastic surgeons reporting the lowest (12.9%) followed by ophthalmology (16.0%) and hand (18.6%). Surgeons in group practices and integrated systems were more likely to participate relative to those practicing independently (aOR 1.57, 95% CI 1.50, 1.64; aOR 4.87, 95% CI 4.68, 5.07, respectively). We observed a statistically significant interaction (P <0.001) between surgical specialty and practice organization. Model-derived predicted probabilities revealed that, within each specialty, surgeons in integrated health systems had the highest predicted probabilities of ACO and those practicing independently generally had the lowest. We observed considerable variation in ACO enrollment among US surgeons, mediated at least in part by differences in practice organization. These data underscore the need for development of frameworks to characterize the strategic advantages and disadvantages associated with APM participation.

  20. The Hidden Roles That Management Partners Play In Accountable Care Organizations.

    PubMed

    Lewis, Valerie A; D'Aunno, Thomas; Murray, Genevra F; Shortell, Stephen M; Colla, Carrie H

    2018-02-01

    Accountable care organizations (ACOs) are often discussed and promoted as driven by physicians, hospitals, and other health care providers. However, because of the flexible nature of ACO contracts, management organizations may also become partners in ACOs. We used data from 2013-15 on 276 ACOs from the National Survey of Accountable Care Organizations to understand the prevalence of nonprovider management partners' involvement in ACOs, the services these partners provide, and the structure of ACOs that have such partners. We found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards. Among ACOs with partners, 94 percent had data services provided by the partner, 87 percent received administrative services, 68 percent received educational services, and 66 percent received care coordination services. Half received all four of these services from their partner. ACOs with partners were more heavily primary care than other ACOs. ACOs with and without partners had similar performance on costs and quality in Medicare ACO programs. Our findings suggest that management partners play a central role in many ACOs, perhaps supplying smaller and physician-run ACOs with services or expertise perceived as necessary for ACO success.

  1. Accountable care organizations and the allergist: challenges and opportunities.

    PubMed

    Ein, Daniel; Foggs, Michael B

    2014-01-01

    For decades, health care policy experts have wrestled with ways to solve problems of access, cost, and quality in US health care. The current consensus is that the solution to all three lies in changing financial incentives for providers and delivering care through integrated systems. The currently favored vehicle for this, both in the public and private sectors, is through Accountable Care Organizations (ACOs). Medicare has several models and has fostered rapid growth in the number of operative ACOs. At least an equal number of private ACOs are in operation. Whether or not these organizations will fulfill their promise is unknown but there is reason for cautious optimism. Allergists can and should be part of the process of this transformation in our health care system. They can be integral to helping these organizations save money by reducing hospitalizations and improving the quality of allergy and asthma care in the populations served. In order to accomplish this, allergists must become more involved in their medical communities and hospitals. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  2. Integration of Substance Abuse Treatment Organizations into Accountable Care Organizations: Results from a National Survey.

    PubMed

    D'Aunno, Thomas; Friedmann, Peter D; Chen, Qixuan; Wilson, Donna M

    2015-08-01

    To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system. Copyright © 2015 by Duke University Press.

  3. Creating Accountable Care Organizations: The Extended Hospital Medical Staff

    PubMed Central

    Fisher, Elliott S.; Staiger, Douglas O.; Bynum, Julie P.W.; Gottlieb, Daniel J.

    2007-01-01

    Many current policies and approaches to performance measurement and payment reform focus on individual providers; they risk reinforcing the fragmented care and lack of coordination experienced by patients with serious illness. In this paper we show that Medicare beneficiaries receive most of their care from relatively coherent local delivery systems comprising physicians and the hospitals where they work or admit their patients. Efforts to create accountable care organizations at this level—the extended hospital medical staff—deserve consideration as a potential means of improving the quality and lowering the cost of care. PMID:17148490

  4. 17 CFR 274.11b - Form N-3, registration statement of separate accounts organized as management investment companies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... statement of separate accounts organized as management investment companies. 274.11b Section 274.11b... accounts organized as management investment companies. Form N-3 shall be used as the registration statement... offer variable annuity contracts to register as management investment companies. This form shall also be...

  5. 17 CFR 239.17a - Form N-3, registration statement for separate accounts organized as management investment companies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... statement for separate accounts organized as management investment companies. 239.17a Section 239.17a... accounts organized as management investment companies. Form N-3 shall be used for registration under the... register under the Investment Company Act of 1940 as management investment companies, and certain other...

  6. Accountable Care Organizations in California: Market Forces at Work?

    PubMed

    Whaley, Christopher; Frech, H E; Scheffler, Richard M

    2015-08-01

    Accountable care organizations (ACOs), one of the most recent and promising health care delivery innovations, encourage care coordination among providers. While ACOs hold promise for decreasing costs by reducing unnecessary procedures, improving resource use as a result of economies of scale and scope, ACOs also raise concerns about provider market power. This study examines the market-level competition factors that are associated with ACO participation and the number of ACOs. Using data from California, we find that higher levels of preexisting managed care leads to higher ACO entry and enrollment growth, while hospital concentration leads to fewer ACOs and lower enrollment. We find interesting results for physician market power - markets with concentrated physician markets have a smaller share of individuals in commercial ACOs but a larger number of commercial ACO organizations. This finding implies smaller ACOs in these markets. Copyright © 2015 by Duke University Press.

  7. An alternative approach to account for patient organ doses from imaging guidance procedures.

    PubMed

    Nelson, Alan P; Ding, George X

    2014-07-01

    To investigate the feasibility of an alternative method of accounting for additional organ doses resulting from image guidance procedures during patient treatment planning through tabulated values based on scan protocol and scan site. Patient-specific imaging dose to 30 patients resulting from Varian OBI kV-CBCT scans using the Standard Head (17 patients), Low-dose Thorax (8 patients), and Pelvic (5 patients) scan protocols were retrospectively calculated using Monte Carlo methods. Dose dependence on scan location and patient geometry was explored. Patient organ doses were analyzed by using dose-volume histograms and expressed by the mean, minimum dose delivered to 50% of the organ volume, D50. The reported doses are dose-to-medium instead of dose-to-water. The organ doses from all patient-specific calculations show predictable and limited ranges across patients. For brain isocenters using Standard Head Scans: Bone: 0.7-1.1 cGy, Brain: 0.2-0.3 cGy, Brainstem: 0.2-0.3 cGy, Skin: 0.3-0.4 cGy, Eye: 0.03-0.3 cGy. For head and neck patients using the Standard Head Scan: Bone: 0.3-0.6 cGy, Parotids: 0.3-0.4 cGy, Spinal Cord: 0.15-0.25 cGy, Thyroid: 0.1-0.25 cGy, Skin: 0.2-0.3 cGy, Trachea-Esophagus: 0.1-0.2 cGy. For chest using Thorax Scans: Bone: 1.1-1.8 cGy, Soft tissue organs (Bowel, Lung, Heart, Kidney, Esophagus, and Spinal Cord): 0.3-0.6 cGy. For abdominal site using Pelvic Scans: Bone: 3.2-4.2 cGy. Soft tissue organs (Bladder, Bowel, Rectum, Prostate, and Skin) D50s fell between 1.2 and 2.2 cGy. Femoral Heads: 2.5-3.4 cGy. It is adequate to estimate and account for organ dose by using tabulated values based on scan procedure and site because organ doses from imaging procedures are only modestly dependent upon scan location and body size. Considering the dose variation and magnitude of dose from each scan protocol in comparison to therapeutic doses, this approach provides a simple alternative to account for additional imaging guidance doses during patient treatment

  8. The effect of accountable care organizations on oncology practice.

    PubMed

    Shulman, Lawrence N

    2014-01-01

    Cancer care accounts for a significant portion of the rise in health care costs, and therefore, as national efforts escalate to control cost, cancer care will be a focus of concern. Cost increases in cancer care are related to many factors, including increasing cancer incidence in an aging population, the introduction of new high-cost therapeutics, and the high cost of end-of-life care. Accountable care organizations (ACOs) have been one of the major efforts directed at controlling health care costs. How cancer care will fit into the rubric of ACOs is not entirely clear but will certainly evolve over the coming years. The oncology profession has the opportunity to play a role in this evolution or could leave the evolution to others driving the process, such as the Centers for Medicare and Medicaid Services (CMS), private payers, and ACOs. Ideally all parties will work together to provide a construct for high-value, high-quality care for patients with cancer while contributing to cost control in overall health care.

  9. The potential impact of accountable care organizations with respect to cost and quality with special attention to imaging.

    PubMed

    Mukherji, Suresh K

    2014-04-01

    An accountable care organization is a form of a managed care organization in which a group of networked health care providers, which may include hospitals, group practices, networks of practices, hospital-provider partnerships, or joint ventures, are accountable for the health care of a defined group of patients. Initial results of the institutions participating in CMS's Physician Group Demonstration Project did not demonstrate a substantial reduction in imaging that could be directly attributed to the accountable care organization model. However, the initial results suggest that incentive-based methodology appears to be successful for increasing compliance for measuring quality metrics. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. FASB (Financial Accounting Standards Board) proposal changes retiree healthcare benefit accounting.

    PubMed

    Grimaldi, P L; Bertko, J M

    1989-07-01

    The Financial Accounting Standards Board (FASB) recently issued an exposure draft (ED) of a standard that would change the way organizations account for their employees' post-retirement healthcare benefits. According to the ED, organizations would have to switch from cash accounting to accrual accounting for post-retirement benefits as well as record their retiree healthcare liabilities on their balance sheets by 1992.

  11. Care coordination in accountable care organizations: moving beyond structure and incentives.

    PubMed

    Press, Matthew J; Michelow, Marilyn D; MacPhail, Lucy H

    2012-12-01

    Accountable care organizations (ACOs) are considered by many to be a key component of healthcare delivery system improvement. One expectation is that the structural elements of the ACO model, including clinical integration and financial accountability, will lead to better coordination of care for patients. But, while structure and incentives may facilitate the delivery of coordinated care, they will not necessarily ensure that care coordination is done well. For that, physicians and other healthcare providers within ACOs must possess and utilize specific skills, particularly in the areas of collaboration, communication, and teamwork. In this article, we present strategies in 3 domains--training, support tools, and organizational culture--that ACOs can implement to foster the development of these skills and support their use in clinical practice.

  12. Applying Organization Theory to Understanding the Adoption and Implementation of Accountable Care Organizations: Commentary.

    PubMed

    Shortell, Stephen M

    2016-12-01

    This commentary highights the key arguments and contributions of institutional thoery, transaction cost economics (TCE) theory, high reliability theory, and organizational learning theory to understanding the development and evolution of Accountable Care Organizations (ACOs). Institutional theory and TCE theory primarily emphasize the external influences shaping ACOs while high reliability theory and organizational learning theory underscore the internal fctors influencing ACO perfromance. A framework based on Implementation Science is proposed to conside the multiple perspectives on ACOs and, in particular, their abiity to innovate to achieve desired cost, quality, and population health goals. © The Author(s) 2016.

  13. A Two-Step Method to Identify Positive Deviant Physician Organizations of Accountable Care Organizations with Robust Performance Management Systems.

    PubMed

    Pimperl, Alexander F; Rodriguez, Hector P; Schmittdiel, Julie A; Shortell, Stephen M

    2018-06-01

    To identify positive deviant (PD) physician organizations of Accountable Care Organizations (ACOs) with robust performance management systems (PMSYS). Third National Survey of Physician Organizations (NSPO3, n = 1,398). Organizational and external factors from NSPO3 were analyzed. Linear regression estimated the association of internal and contextual factors on PMSYS. Two cutpoints (75th/90th percentiles) identified PDs with the largest residuals and highest PMSYS scores. A total of 65 and 41 PDs were identified using 75th and 90th percentiles cutpoints, respectively. The 90th percentile more strongly differentiated PDs from non-PDs. Having a high proportion of vulnerable patients appears to constrain PMSYS development. Our PD identification method increases the likelihood that PD organizations selected for in-depth inquiry are high-performing organizations that exceed expectations. © Health Research and Educational Trust.

  14. 75 FR 57039 - Medicare Program; Workshop Regarding Accountable Care Organizations, and Implications Regarding...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-17

    ... panel discussions and a listening session on certain legal issues related to Accountable Care Organizations (ACOs). Physicians, physician associations, hospitals, health systems, consumers, and all others...-mail to [email protected] or sent via regular mail to: Attn: ACO Legal Issues, Mail Stop C5-15...

  15. Primary Care Clinics and Accountable Care Organizations

    PubMed Central

    Tang, Chiung-Ya; Lin, Yi-Ling; Masri, Maysoun D.

    2015-01-01

    Background: The Accountable Care Organization (ACO) is one of the new models of health care delivery in the United States. To date, little is known about the characteristics of health care organizations that have joined ACOs. We report on the findings of a survey of primary care clinics, the objective of which was to investigate the opinions of clinic management about participation in ACOs and the characteristics of clinic organizational structure that may contribute to joining ACOs or be willing to do so. Methods: A 27-item survey questionnaire was developed and distributed by mail in 3 annual waves to all Rural Health Clinics (RHCs) in 9 states. Two dependent variables—participation in ACOs and willingness to join ACOs—were created and analyzed using a generalized estimating equation approach. Results: A total of 257 RHCs responded to the survey. A small percentage (5.2%) of the respondent clinics reported that they were participating in ACOs. Rural Health Clinics in isolated areas were 78% less likely to be in ACOs (odds ratio = 0.22, P = .059). Nonprofit RHCs indicated a higher willingness to join an ACO than for-profit RHCs (B = 1.271, P = .054). There is a positive relationship between RHC size and willingness to join an ACO (B = 0.402, P = .010). Conclusion: At this early stage of ACO development, many RHC personnel are unfamiliar with the ACO model. Rural providers’ limited technological and human resources, and the lack of ACO development in rural areas, may delay or prevent their participation in ACOs. PMID:26900587

  16. A self-organizing learning account of number-form synaesthesia.

    PubMed

    Makioka, Shogo

    2009-09-01

    Some people automatically and involuntarily "see" mental images of numbers in spatial arrays when they think of numbers. This phenomenon, called number forms, shares three key characteristics with the other types of synaesthesia, within-individual consistency, between-individual variety, and mixture of regularity and randomness. A theoretical framework called SOLA (self-organizing learning account of number forms) is proposed, which explains the generation process of number forms and the origin of those three characteristics. The simulations replicated the qualitative properties of the shapes of number forms, the property that numbers are aligned in order of size, that discontinuity usually occurs at the point of carry, and that continuous lines tend to have many bends.

  17. Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices.

    PubMed

    Conway, Sarah J; Himmelrich, Sarah; Feeser, Scott A; Flynn, John A; Kravet, Steven J; Bailey, Jennifer; Hebert, Lindsay C; Donovan, Susan H; Kachur, Sarah G; Brown, Patricia M C; Baumgartner, William A; Berkowitz, Scott A

    2018-02-02

    Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients.

  18. How to Organize and Communicatre Your Energy Data. A Guide to Energy Accounting.

    ERIC Educational Resources Information Center

    Cornwall, Bonnie J.

    Stategies for organizing data on a district's energy use are presented in this guide, originally intended for use in California schools. Also presented are methods of communicating this information to those involved in planning, in recordkeeping, and in motivating staff and students to save energy. The energy accounting system offered in the first…

  19. Optimization of Medication Use at Accountable Care Organizations.

    PubMed

    Wilks, Chrisanne; Krisle, Erik; Westrich, Kimberly; Lunner, Kristina; Muhlestein, David; Dubois, Robert

    2017-10-01

    Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather data on the actions accountable care organizations (ACOs) have taken to optimize medication use. To (a) assess how ACOs optimize medication use; (b) establish an association between efforts to optimize medication use and achievement on financial and quality metrics; (c) identify organizational factors that correlate with optimized medication use; and (d) identify barriers to optimized medication use. This cross-sectional study consisted of a survey and interviews that gathered information on the perceptions of ACO leadership. The survey contained a medication practices inventory (MPI) composed of 38 capabilities across 6 functional domains related to optimizing medication use. ACOs completed self-assessments that included rating each component of the MPI on a scale of 1 to 10. Fisher's exact tests, 2-proportions tests, t-tests, and logistic regression were used to test for associations between ACO scores on the MPI and performance on financial and quality metrics, and on ACO descriptive characteristics. Of the 847 ACOs that were contacted, 49 provided usable survey data. These ACOs rated their own system's ability to manage the quality and costs of optimizing medication use, providing a 64% and 31% affirmative response, respectively. Three ACOs achieved an overall MPI score of 8 or higher, 45 scored between 4 and 7.9, and 1 scored between 0 and 3.9. Using the 3 score groups, the study did not identify a relationship between MPI scores and achievement on financial or quality benchmarks, ACO provider type, member volume, date of ACO creation, or the presence of a pharmacist in a leadership position. Barriers to optimizing medication use relate to reimbursement for pharmacist integration, lack of health information technology interoperability, lack of data, feasibility issues, and physician buy

  20. Roles for specialty societies and vascular surgeons in accountable care organizations.

    PubMed

    Goodney, Philip P; Fisher, Elliott S; Cambria, Richard P

    2012-03-01

    With the passage of the Affordable Care Act, accountable care organizations (ACOs) represent a new paradigm in healthcare payment reform. Designed to limit growth in spending while preserving quality, these organizations aim to incant physicians to lower costs by returning a portion of the savings realized by cost-effective, evidence-based care back to the ACO. In this review, first, we will explore the development of ACOs within the context of prior attempts to control Medicare spending, such as the sustainable growth rate and managed care organizations. Second, we describe the evolution of ACOs, the demonstration projects that established their feasibility, and their current organizational structure. Third, because quality metrics are central to the use and implementation of ACOs, we describe current efforts to design, collect, and interpret quality metrics in vascular surgery. And fourth, because a "seat at the table" will be an important key to success for vascular surgeons in these efforts, we discuss how vascular surgeons can participate and lead efforts within ACOs. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  1. Roles for specialty societies and vascular surgeons in accountable care organizations

    PubMed Central

    Goodney, Philip P.; Fisher, Elliott S.; Cambria, Richard P.

    2012-01-01

    With the passage of the Affordable Care Act, accountable care organizations (ACOs) represent a new paradigm in healthcare payment reform. Designed to limit growth in spending while preserving quality, these organizations aim to incant physicians to lower costs by returning a portion of the savings realized by cost-effective, evidence-based care back to the ACO. In this review, first, we will explore the development of ACOs within the context of prior attempts to control Medicare spending, such as the sustainable growth rate and managed care organizations. Second, we describe the evolution of ACOs, the demonstration projects that established their feasibility, and their current organizational structure. Third, because quality metrics are central to the use and implementation of ACOs, we describe current efforts to design, collect, and interpret quality metrics in vascular surgery. And fourth, because a “seat at the table” will be an important key to success for vascular surgeons in these efforts, we discuss how vascular surgeons can participate and lead efforts within ACOs. PMID:22370029

  2. Accountable Care Organization Implementation Experiences and Rural Participation: Considerations for Nurses.

    PubMed

    Bagwell, Matt Thomas; Bushy, Angeline; Ortiz, Judith

    2017-01-01

    Little is known about how accountable care organizations (ACOs) participate with rural health providers. This pilot study examines ACO participation with rural health clinics (RHCs). Telephone interviews with 8 ACO administrators were conducted to determine the early implementation experiences of these organizations, and their participation with rural health providers, such as RHCs, using qualitative content analysis, ACO characteristics, and emerging themes from the ACO executive responses was identified. Three predominant themes emerged: 1) ACOs are growing in size and number and have various organizational structures; 2) there is an expanding emphasis on preventive primary care and chronic disease management for patients; and 3) there is a need for improved information technology integration with clinical services and financial systems. Of 8 participants, 7 reported that their ACO was planning to expand into rural areas and partner with rural providers.

  3. Integration Strategies of Pharmacists in Primary Care-Based Accountable Care Organizations: A Report from the Accountable Care Organization Research Network, Services, and Education.

    PubMed

    Joseph, Tina; Hale, Genevieve M; Eltaki, Sara M; Prados, Yesenia; Jones, Renee; Seamon, Matthew J; Moreau, Cynthia; Gernant, Stephanie A

    2017-05-01

    The accountable care organization (ACO) is an innovative health care delivery model centered on value-based care. ACOs consisting of primary care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal. As experts in medication management, pharmacists perform direct patient care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient care. Pharmacist-provided care has been shown to reduce drug expenditures, hospital readmissions, length of stay, and emergency department visits. Although pharmacists have become key team members of interdisciplinary teams within traditional care settings, their role has often been overlooked in the primary care-based ACO. In 2015, Nova Southeastern University College of Pharmacy founded the Accountable Care Organization Research Network, Services, and Education (ACORN SEED), a team of pharmacy practice faculty dedicated to using innovative approaches to patient care, while providing unique learning experiences for pharmacy students by partnering with ACOs in the South Florida region. Five opportunities are presented for pharmacists to improve medication use specifically in primary care-based ACOs: medication therapy management, annual wellness visits, chronic disease state management, chronic care management, and transitions of care. Several challenges and barriers that prevent the full integration of pharmacists into primary care-based ACOs include lack of awareness of pharmacist roles in primary care; complex laws and regulations surrounding clinical protocols, such as collaborative practice agreements; provider status that allows compensation for pharmacist services; and limited access to medical records. By understanding and maximizing the role of pharmacists, several opportunities exist to better manage the medication-use process in value-based care settings. As more organizations realize

  4. Can the Accountable Care Organization model facilitate integrated care in England?

    PubMed

    Ahmed, Faheem; Mays, Nicholas; Ahmed, Naeem; Bisognano, Maureen; Gottlieb, Gary

    2015-10-01

    Following the global economic recession, health care systems have experienced intense political pressure to contain costs without compromising quality. One response is to focus on improving the continuity and coordination of care, which is seen as beneficial for both patients and providers. However, cultural and structural barriers have proved difficult to overcome in the quest to provide integrated care for entire populations. By holding groups of providers responsible for the health outcomes of a designated population, in the United States, Accountable Care Organizations are regarded as having the potential to foster collaboration across the continuum of care. They could have a similar role in England's National Health Service. However, it is important to consider the difference in context before implementing a similar model, adapted to suit the system's strengths. Working together, general practice federations and the Academic Health Science Networks could form the basis of accountable care in England. © The Author(s) 2015.

  5. FASB (Financial Accounting Standards Board) issues new accounting rules for debt and equity securities.

    PubMed

    Reinstein, A; Bayou, M E

    1994-10-01

    The Financial Accounting Standards Board (FASB) recently issued a new statement that requires all companies to change their methods of accounting for debt and equity securities. Rather than allowing organizations to use a historical cost approach in accounting for such financial instruments, FASB Statement No. 115 requires organizations to adopt a market value approach. The provisions of this statement will affect significantly organizations in the healthcare industry that have large investment portfolios.

  6. The changing roles of registered nurses in Pioneer Accountable Care Organizations.

    PubMed

    Pittman, Patricia; Forrest, Emily

    2015-01-01

    This study focuses on whether and how Pioneer Accountable Care Organization (ACO) leaders believe the deployment of the registered nurse workforce is changing in response to the shared savings incentives. Semistructured phone interviews with leaders from 18 of the original 32 Pioneer ACOs were conducted. Narrative analysis suggests that all of the organizations are developing new and enhanced roles for registered nurses across the continuum of care. Overall, eight types of changes were reported: enhancement of roles, substitution, delegation, increased numbers of nurses, relocation of services, transfer of nurses from one setting to another, the use of liaison nurses across settings, and partnerships between nurses coordinating care in primary and acute care settings. This exploratory study suggests that Pioneer ACO leaders believe that payment models are affecting the deployment of the health workforce and that these changes are, in turn, driving outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Interpretations of integration in early accountable care organizations.

    PubMed

    Kreindler, Sara A; Larson, Bridget K; Wu, Frances M; Carluzzo, Kathleen L; Gbemudu, Josette N; Struthers, Ashley; VAN Citters, Aricca D; Shortell, Stephen M; Nelson, Eugene C; Fisher, Elliott S

    2012-09-01

    It is widely hoped that accountable care organizations (ACOs) will improve health care quality and reduce costs by fostering integration among diverse provider groups. But how do implementers actually envision integration, and what will integration mean in terms of managing the many social identities that ACOs bring together? Using the lens of the social identity approach, this qualitative study examined how four nascent ACOs engaged with the concept of integration. During multiday site visits, we conducted interviews (114 managers and physicians), observations, and document reviews. In no case was the ACO interpreted as a new, overarching entity uniting disparate groups; rather, each site offered a unique interpretation that flowed from its existing strategies for social-identity management: An independent practice association preserved members' cherished value of autonomy by emphasizing coordination, not "integration"; a medical group promoted integration within its employed core, but not with affiliates; a hospital, engaging community physicians who mistrusted integrated systems, reimagined integration as an equal partnership; an integrated delivery system advanced its careful journey towards intergroup consensus by presenting the ACO as a cultural, not structural, change. The ACO appears to be a model flexible enough to work in synchrony with whatever social strategies are most context appropriate, with the potential to promote alignment and functional integration without demanding common identification with a superordinate group. "Soft integration" may be a promising alternative to the vertically integrated model that, though widely assumed to be ideal, has remained unattainable for most organizations. © 2012 Milbank Memorial Fund.

  8. Health care delivery system reform: accountable care organizations.

    PubMed

    Dove, James T; Weaver, W Douglas; Lewin, Jack

    2009-09-08

    Health care reform is moving forward at a frantic pace. There have been 3 documents released from the Senate Finance Committee and proposed legislation from the Senate HELP Committee and the House of Representatives Tri-Committee on Health Reform. The push for legislative action has not been sidetracked by the economic conditions. Integrated health care delivery is the current favored approach to aligning resource use and cost. Accountable care organizations (ACOs), a concept included in health care reform legislation before both the House and Senate, propose to translate the efficiencies and lessons learned from large integrated systems and apply them to nonintegrated practices. The ACO design could be real or virtual integration of local delivery providers. This new structure is complicated, and clinicians, patients, and payers should have input regarding the design and function of it. Because most of health care is delivered in the ambulatory setting, it remains to be determined whether the ACOs are best developed in parallel among physician practices and hospitals or as partnerships between hospitals and physicians. Many are concerned that hospital-led ACOs will force physician employment by hospitals with possible unintended negative consequences for physicians, hospitals, and patients. Patients, physicians, other providers, and payers are in a better position to guide the redesign of the health care delivery system than government agencies, policy organizations, or elected officials, no matter how well intended. We strongly believe-and ACC has proclaimed-that change in health care delivery must be accomplished with patients and physicians at the table.

  9. Interpretations of Integration in Early Accountable Care Organizations

    PubMed Central

    Kreindler, Sara A; Larson, Bridget K; Wu, Frances M; Carluzzo, Kathleen L; Gbemudu, Josette N; Struthers, Ashley; Van Citters, Aricca D; Shortell, Stephen M; Nelson, Eugene C; Fisher, Elliott S

    2012-01-01

    Context It is widely hoped that accountable care organizations (ACOs) will improve health care quality and reduce costs by fostering integration among diverse provider groups. But how do implementers actually envision integration, and what will integration mean in terms of managing the many social identities that ACOs bring together? Methods Using the lens of the social identity approach, this qualitative study examined how four nascent ACOs engaged with the concept of integration. During multiday site visits, we conducted interviews (114 managers and physicians), observations, and document reviews. Findings In no case was the ACO interpreted as a new, overarching entity uniting disparate groups; rather, each site offered a unique interpretation that flowed from its existing strategies for social-identity management: An independent practice association preserved members’ cherished value of autonomy by emphasizing coordination, not “integration”; a medical group promoted integration within its employed core, but not with affiliates; a hospital, engaging community physicians who mistrusted integrated systems, reimagined integration as an equal partnership; an integrated delivery system advanced its careful journey towards intergroup consensus by presenting the ACO as a cultural, not structural, change. Conclusions The ACO appears to be a model flexible enough to work in synchrony with whatever social strategies are most context appropriate, with the potential to promote alignment and functional integration without demanding common identification with a superordinate group. “Soft integration” may be a promising alternative to the vertically integrated model that, though widely assumed to be ideal, has remained unattainable for most organizations. PMID:22985278

  10. How the center for Medicare and Medicaid innovation should test accountable care organizations.

    PubMed

    Shortell, Stephen M; Casalino, Lawrence P; Fisher, Elliott S

    2010-07-01

    The Patient Protection and Affordable Care Act establishes a national voluntary program for accountable care organizations (ACOs) by January 2012 under the auspices of the Centers for Medicare and Medicaid Services (CMS). The act also creates a Center for Medicare and Medicaid Innovation in the CMS. We propose that the CMS allow flexibility and tiers in ACOs based on their specific circumstances, such as the degree to which they are or are not fully integrated systems. Further, we propose that the CMS assume responsibility for ACO provisions and develop an ordered system for learning how to create and sustain ACOs. Key steps would include setting specific performance goals, developing skills and tools that facilitate change, establishing measurement and accountability mechanisms, and supporting leadership development.

  11. An Institutional Perspective on Accountable Care Organizations.

    PubMed

    Goodrick, Elizabeth; Reay, Trish

    2016-12-01

    We employ aspects of institutional theory to explore how Accountable Care Organizations (ACOs) can effectively manage the multiplicity of ideas and pressures within which they are embedded and consequently better serve patients and their communities. More specifically, we draw on the concept of institutional logics to highlight the importance of understanding the conflicting principles upon which ACOs were founded. Based on previous research conducted both inside and outside health care settings, we argue that ACOs can combine attention to these principles (or institutional logics) in different ways; the options fall on a continuum from (a) segregating the effects of multiple logics from each other by compartmentalizing responses to multiple logics to (b) fully hybridizing the different logics. We suggest that the most productive path for ACOs is to situate their approach between the two extremes of "segregating" and "fully hybridizing." This strategic approach allows ACOs to develop effective responses that combine logics without fully integrating them. We identify three ways that ACOs can embrace institutional complexity short of fully hybridizing disparate logics: (1) reinterpreting practices to make them compatible with other logics; (2) engaging in strategies that take advantage of existing synergy between conflicting logics; (3) creating opportunities for people at frontline to develop innovative ways of working that combine multiple logics. © The Author(s) 2016.

  12. World Health Organization and the search for accountability: a critical analysis of the new framework of engagement with non-state actors.

    PubMed

    Rached, Danielle Hanna; Ventura, Deisy de Freitas Lima

    2017-07-03

    The article probes the origins and content of the Framework of Engagement with Non-State Actors (FENSA) of the World Health Organization (WHO), approved on May 28, 2016, at the 69th World Health Assembly, which established different rules of collaboration to four categories of actors: nongovernmental organizations (NGOs), private sector entities, philanthropic foundations, and academic institutions. Applying the findings of International Legal Theory and based on extensive documentary research, we sought to determine whether FENSA is an appropriate accountability mechanism according to four functions of accountability: constitutional, democratic, epistemic, and populist. The article concludes that there is a risk of the prevalence of the populist function at the expense of the accountability potential that could result from the better use of the other three accountability functions.

  13. The Organizational Account of Function is an Etiological Account of Function.

    PubMed

    Artiga, Marc; Martínez, Manolo

    2016-06-01

    The debate on the notion of function has been historically dominated by dispositional and etiological accounts, but recently a third contender has gained prominence: the organizational account. This original theory of function is intended to offer an alternative account based on the notion of self-maintaining system. However, there is a set of cases where organizational accounts seem to generate counterintuitive results. These cases involve cross-generational traits, that is, traits that do not contribute in any relevant way to the self-maintenance of the organism carrying them, but instead have very important effects on organisms that belong to the next generation. We argue that any plausible solution to the problem of cross-generational traits shows that the organizational account just is a version of the etiological theory and, furthermore, that it does not provide any substantive advantage over standard etiological theories of function.

  14. Applying Organizational Learning Research to Accountable Care Organizations.

    PubMed

    Nembhard, Ingrid M; Tucker, Anita L

    2016-12-01

    To accomplish the goal of improving quality of care while simultaneously reducing cost, Accountable Care Organizations (ACOs) need to find new and better ways of providing health care to populations of patients. This requires implementing best practices and improving collaboration across the multiple entities involved in care delivery, including patients. In this article, we discuss seven lessons from the organizational learning literature that can help ACOs overcome the inherent challenges of learning how to work together in radically new ways. The lessons involve setting expectations, creating a supportive culture, and structuring the improvement efforts. For example, with regard to setting expectations, framing the changes as learning experiences rather than as implementation projects encourages the teams to utilize helpful activities, such as dry runs and pilot tests. It is also important to create an organizational culture where employees feel safe pointing out improvement opportunities and experimenting with new ways of working. With regard to structure, stable, cross-functional teams provide a powerful building block for effective improvement efforts. The article concludes by outlining opportunities for future research on organizational learning in ACOs. © The Author(s) 2016.

  15. Implementation of a pilot accountable care organization payment model and the use of discretionary and nondiscretionary cardiovascular care.

    PubMed

    Colla, Carrie H; Goodney, Philip P; Lewis, Valerie A; Nallamothu, Brahmajee K; Gottlieb, Daniel J; Meara, Ellen

    2014-11-25

    Accountable care organizations (ACOs) seek to reduce growth in healthcare spending while ensuring high-quality care. We hypothesized that accountable care organization implementation would selectively limit the use of discretionary cardiovascular care (defined as care occurring in the absence of indications such as myocardial infarction or stroke), while maintaining high-quality care, such as nondiscretionary cardiovascular imaging and procedures. The intervention group was composed of fee-for-service Medicare patients (n=819 779) from 10 groups participating in a Medicare pilot accountable care organization, the Physician Group Practice Demonstration (PGPD). Matched controls were patients (n=934 621) from nonparticipating groups in the same regions. We compared use of cardiovascular care before (2002-2004) and after (2005-2009) PGPD implementation, studying both discretionary and nondiscretionary carotid and coronary imaging and procedures. Our main outcome measure was the difference in the proportion of patients treated with imaging and procedures among patients of PGPD practices compared with patients in control practices, before and after PGPD implementation (difference-in-difference). For discretionary imaging, the difference-in-difference between PGPD practices and controls was not statistically significant for discretionary carotid imaging (0.17%; 95% confidence interval, -0.51% to 0.85%; P=0.595) or discretionary coronary imaging (-0.19%; 95% confidence interval, -0.73% to 0.35%; P=0.468). Similarly, the difference-in-difference was also minimal for discretionary carotid revascularization (0.003%; 95% confidence interval, -0.008% to 0.002%; P=0.705) and coronary revascularization (-0.02%; 95% confidence interval, -0.11% to 0.07%; P=0.06). The difference-in-difference associated with PGPD implementation was also essentially 0 for nondiscretionary cardiovascular imaging or procedures. Implementation of a pilot accountable care organization did not limit the

  16. California Health Services/Educational Activities. Consortium Network.

    ERIC Educational Resources Information Center

    White, Charles H.

    Profiles are presented of each of the 10 consortia that make up the California Health Services/Education Activities (HS/EA) network (new relationships between educational facilities where health care manpower is trained in the community settings where they practice). The first part of the booklet is a comparative analysis of (1) Area Health…

  17. The Economics of Medicare Accountable Care Organizations

    PubMed Central

    Blackstone, Erwin A.; Fuhr, Joseph P.

    2016-01-01

    Background Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. Objective To examine whether the current Medicare ACOs are likely to be successful. Discussion Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. Conclusion The question remains whether Medicare ACOs can achieve the Triple Aim of “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs. PMID:27066191

  18. The Economics of Medicare Accountable Care Organizations.

    PubMed

    Blackstone, Erwin A; Fuhr, Joseph P

    2016-02-01

    Accountable care organizations (ACOs) have been created to improve patient care, enhance population health, and reduce costs. Medicare in particular has focused on ACOs as a primary device to improve quality and reduce costs. To examine whether the current Medicare ACOs are likely to be successful. Patients receiving care in ACOs have little incentive to use low-cost quality providers. Furthermore, the start-up costs of ACOs for providers are high, contributing to the minimal financial success of ACOs. We review issues such as reducing readmissions, palliative care, and the difficulty in coordinating care, which are major cost drivers. There are mixed incentives facing hospital-controlled ACOs, whereas physician-controlled ACOs could play hospitals against each other to obtain high quality and cost reductions. This discussion also considers whether the current structure of ACOs is likely to be successful. The question remains whether Medicare ACOs can achieve the Triple Aim of "improving the experience of care, improving the health of populations, and reducing per capita costs of health care." Care coordination in ACOs and information technology are proving more complicated and expensive to implement than anticipated. Even if ACOs can decrease healthcare costs and increase quality, it is unclear if the current incentives system can achieve these objectives. A better public policy may be to implement a system that encompasses the best practices of successful private integrated systems rather than promoting ACOs.

  19. Regulatory neutrality is essential to establishing a level playing field for accountable care organizations.

    PubMed

    Bacher, Gary E; Chernew, Michael E; Kessler, Daniel P; Weiner, Stephen M

    2013-08-01

    Accountable care organizations (ACOs) are among the most widely discussed models for encouraging movement away from fee-for-service payment arrangements. Although ACOs have the potential to slow health spending growth and improve quality of care, regulating them poses special challenges. Regulations, particularly those that affect both ACOs and Medicare Advantage plans, could inadvertently favor or disfavor certain kinds of providers or payers. Such favoritism could drive efficient organizations from the market and thus increase costs or reduce quality of and access to care. To avoid this type of outcome, we propose a general principle: Regulation of ACOs should strive to preserve a level playing field among different kinds of organizations seeking the same cost, quality, and access objectives. This is known as regulatory neutrality. We describe the implications of regulatory neutrality in four key areas: antitrust, financial solvency regulation, Medicare governance requirements, and Medicare payment models. We also discuss issues relating to short-term versus long-term perspectives--to promote the goal of regulatory neutrality and allow the most efficient organizations to prevail in the marketplace.

  20. Early Impact of Medicare Accountable Care Organizations on Inpatient Surgical Spending.

    PubMed

    Nathan, Hari; Thumma, Jyothi R; Ryan, Andrew M; Dimick, Justin B

    2018-05-16

    To evaluate whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery. ACOs have proliferated rapidly and now cover more than 32 million Americans. Medicare Shared Savings Program (MSSP) ACOs have shown modest success in reducing medical spending. Whether they have reduced surgical spending remains unknown. We used 100% Medicare claims from 2010 to 2014 for patients aged 65 to 99 years undergoing 6 common elective surgical procedures [abdominal aortic aneurysm (AAA) repair, colectomy, coronary artery bypass grafting (CABG), hip or knee replacement, or lung resection]. We compared total Medicare payments for 30-day surgical episodes, payments for individual components of care (index hospitalization, readmissions, physician services, and postacute care), and clinical outcomes for patients treated at MSSP ACO hospitals versus matched controls at non-ACO hospitals. We accounted for preexisting trends independent of ACO participation using a difference-in-differences approach. Among 341,675 patients at 427 ACO hospitals and 1,024,090 matched controls at 1531 non-ACO hospitals, patient and hospital characteristics were well-balanced. Average baseline payments were similar at ACO versus non-ACO hospitals. ACO participation was not associated with reductions in total Medicare payments [difference-in-differences estimate=-$72, confidence interval (CI95%): -$228 to +$84] or individual components of payments. ACO participation was also not associated with clinical outcomes. Duration of ACO participation did not affect our estimates. Although Medicare ACOs have had success reducing spending for medical care, they have not had similar success with surgical spending. Given that surgical care accounts for 30% of total health care costs, ACOs and policymakers must pay greater attention to reducing surgical expenditures.

  1. Willingness to participate in accountable care organizations: health care managers' perspective.

    PubMed

    Wan, Thomas T H; Demachkie Masri, Maysoun; Ortiz, Judith; Lin, Blossom Y J

    2014-01-01

    This study examines how health care managers responded to the accountable care organization (ACO). The effect of perceived benefits and barriers of the commitment to develop a strategic plan for ACOs and willingness to participate in ACOs is analyzed, using organizational social capital, health information technology uses, health systems integration and size of the health networks, geographic factors, and knowledge about ACOs as predictors. Propensity score matching and analysis are used to adjust the state and regional variations. When the number of perceived benefits is greater than the number of perceived barriers, health care managers are more likely to reveal a stronger commitment to develop a strategic plan for ACO adoption. Health care managers who perceived their organizations as lacking leadership support or commitment, financial incentives, and legal and regulatory support to ACO adoption were less willing to participate in ACOs in the future. Future research should gather more diverse views from a larger sample size of health professionals regarding ACO participation. The perspective of health care managers should be seriously considered in the adoption of an innovative health care delivery system. The transparency on policy formulation should consider multiple views of health care managers.

  2. Insights from transformations under way at four Brookings-Dartmouth accountable care organization pilot sites.

    PubMed

    Larson, Bridget K; Van Citters, Aricca D; Kreindler, Sara A; Carluzzo, Kathleen L; Gbemudu, Josette N; Wu, Frances M; Nelson, Eugene C; Shortell, Stephen M; Fisher, Elliott S

    2012-11-01

    This cross-site comparison of the early experience of four provider organizations participating in the Brookings-Dartmouth Accountable Care Organization Collaborative identifies factors that sites perceived as enablers of successful ACO formation and performance. The four pilots varied in size, with between 7,000 and 50,000 attributed patients and 90 to 2,700 participating physicians. The sites had varying degrees of experience with performance-based payments; however, all formed collaborative new relationships with payers and created shared savings agreements linked to performance on quality measures. Each organization devoted major efforts to physician engagement. Policy makers now need to consider how to support and provide incentives for the successful formation of multipayer ACOs, and how to align private-sector and CMS performance measures. Linking providers to learning networks where payers and providers can address common technical issues could help. These sites' transitions to the new payment model constitutes an ongoing journey that will require continual adaptation in the structure of contracts and organizational attributes.

  3. Ethical challenges for accountable care organizations: a structured review.

    PubMed

    DeCamp, Matthew; Farber, Neil J; Torke, Alexia M; George, Maura; Berger, Zackary; Keirns, Carla C; Kaldjian, Lauris C

    2014-10-01

    Accountable care organizations (ACOs) are proliferating as a solution to the cost crisis in American health care, and already involve as many as 31 million patients. ACOs hold clinicians, group practices, and in many circumstances hospitals financially accountable for reducing expenditures and improving their patients' health outcomes. The structure of health care affects the ethical issues arising in the practice of medicine; therefore, like all health care organizational structures, ACOs will experience ethical challenges. No framework exists to assist key ACO stakeholders in identifying or managing these challenges. We conducted a structured review of the medical ACO literature using qualitative content analysis to inform identification of ethical challenges for ACOs. Our analysis found infrequent discussion of ethics as an explicit concern for ACOs. Nonetheless, we identified nine critical ethical challenges, often described in other terms, for ACO stakeholders. Leaders could face challenges regarding fair resource allocation (e.g., about fairly using ACOs' shared savings), protection of professionals' ethical obligations (especially related to the design of financial incentives), and development of fair decision processes (e.g., ensuring that beneficiary representatives on the ACO board truly represent the ACO's patients). Clinicians could perceive threats to their professional autonomy (e.g., through cost control measures), a sense of dual or conflicted responsibility to their patients and the ACO, or competition with other clinicians. For patients, critical ethical challenges will include protecting their autonomy, ensuring privacy and confidentiality, and effectively engaging them with the ACO. ACOs are not inherently more or less "ethical" than other health care payment models, such as fee-for-service or pure capitation. ACOs' nascent development and flexibility in design, however, present a time-sensitive opportunity to ensure their ethical operation

  4. Avoiding potential problems when selling accounts receivable.

    PubMed

    Ayers, D H; Kincaid, T J

    1996-05-01

    Accounts receivable financing is a potential tool for managing a provider organization's working capital needs. But before entering into a financing agreement, organizations need to consider and take steps to avoid serious problems that can arise from participation in an accounts receivable financing program. For example, the purchaser may cease purchasing the receivables, leaving the organization without funding needed for operations. Or, the financing program may be inordinately complex and unnecessarily costly to the organization. Sometimes the organization itself may fail to comply with the terms of the agreement under which the accounts receivable were sold, thus necessitating that restitution be made to the purchaser or provoking charges of fraud. These potential problems should be addressed as early as possible--before an organization enters into an accounts receivable financing program--in order to minimize time, effort, and expanse and maximize the benefits of the financing agreement.

  5. Accountable Care Organizations in the United States: market and demographic factors associated with formation.

    PubMed

    Lewis, Valerie A; Colla, Carrie H; Carluzzo, Kathleen L; Kler, Sarah E; Fisher, Elliott S

    2013-12-01

    The Accountable Care Organization (ACO) model is rapidly being implemented by Medicare, private payers, and states, but little is known about the scope of ACO implementation. To determine the number of accountable care organizations in the United States, where they are located, and characteristics associated with ACO formation. Cross-sectional study of all ACOs in the United States as of August 2012. We identified ACOs from multiple sources; documented service locations (practices, clinics, hospitals); and linked service locations to local areas, defined as Dartmouth Atlas hospital service areas. We used multivariate analysis to assess what characteristics were associated with local ACO presence. We examined demographic characteristics (2010 American Community Survey) and health care system characteristics (2010 Medicare fee-for-service claims data). We identified 227 ACOs located in 27 percent of local areas. Fifty-five percent of the US population resides in these areas. HSA-level characteristics associated with ACO presence include higher performance on quality, higher Medicare per capita spending, fewer primary care physician groups, greater managed care penetration, lower poverty rates, and urban location. Much of the US population resides in areas where ACOs have been established. ACO formation has taken place where it may be easier to meet quality and cost targets. Wider adoption of the ACO model may require tailoring to local context. © Health Research and Educational Trust.

  6. Accountable Care Organizations and Antitrust Enforcement: Promoting Competition and Innovation.

    PubMed

    Feinstein, Deborah L; Kuhlmann, Patrick; Mucchetti, Peter J

    2015-08-01

    The antitrust laws stand to protect consumers of health care services from conduct that would raise prices, lower quality, and decrease innovation by lessening competition. Importantly, though, vigorous antitrust enforcement does not impede accountable care organizations (ACOs) and similar collaborations that advance these same goals of better and more efficient care; in fact, by fostering competitive markets, the antitrust laws encourage such initiatives. This article summarizes the legal framework that the federal antitrust agencies - the Federal Trade Commission and the Antitrust Division of the US Department of Justice - use to analyze ACOs and other collaborations among health care providers. It outlines the guidance provided by the federal antitrust agencies concerning when ACOs and other provider collaborations likely would harm competition and consumers. In addition, it reviews common antitrust issues that can arise with ACOs and provides examples of enforcement actions that have prevented health care providers from taking or continuing anticompetitive actions. Copyright © 2015 by Duke University Press.

  7. Predicting Organic Cation Sorption Coefficients: Accounting for Competition from Sorbed Inorganic Cations Using a Simple Probe Molecule.

    PubMed

    Jolin, William C; Goyetche, Reaha; Carter, Katherine; Medina, John; Vasudevan, Dharni; MacKay, Allison A

    2017-06-06

    With the increasing number of emerging contaminants that are cationic at environmentally relevant pH values, there is a need for robust predictive models of organic cation sorption coefficients (K d ). Current predictive models fail to account for the differences in the identity, abundance, and affinity of surface-associated inorganic exchange ions naturally present at negatively charged receptor sites on environmental solids. To better understand how organic cation sorption is influenced by surface-associated inorganic exchange ions, sorption coefficients of 10 organic cations (including eight pharmaceuticals and two simple probe organic amines) were determined for six homoionic forms of the aluminosilicate mineral, montmorillonite. Organic cation sorption coefficients exhibited consistent trends for all compounds across the various homoionic clays with sorption coefficients (K d ) decreasing as follows: K d Na + > K d NH 4 + ≥ K d K + > K d Ca 2+ ≥ K d Mg 2+ > K d Al 3+ . This trend for competition between organic cations and exchangeable inorganic cations is consistent with the inorganic cation selectivity sequence, determined for exchange between inorganic ions. Such consistent trends in competition between organic and inorganic cations suggested that a simple probe cation, such as phenyltrimethylammonium or benzylamine, could capture soil-to-soil variations in native inorganic cation identity and abundance for the prediction of organic cation sorption to soils and soil minerals. Indeed, sorption of two pharmaceutical compounds to 30 soils was better described by phenyltrimethylammonium sorption than by measures of benzylamine sorption, effective cation exchange capacity alone, or a model from the literature (Droge, S., and Goss, K. Environ. Sci. Technol. 2013, 47, 14224). A hybrid approach integrating structural scaling factors derived from this literature model of organic cation sorption, along with phenyltrimethylammonium K d values, allowed for

  8. Questioning Stakeholder Legitimacy: A Philanthropic Accountability Model.

    PubMed

    Kraeger, Patsy; Robichau, Robbie

    2017-01-01

    Philanthropic organizations contribute to important work that solves complex problems to strengthen communities. Many of these organizations are moving toward engaging in public policy work, in addition to funding programs. This paper raises questions of legitimacy for foundations, as well as issues of transparency and accountability in a pluralistic democracy. Measures of civic health also inform how philanthropic organizations can be accountable to stakeholders. We propose a holistic model for philanthropic accountability that combines elements of transparency and performance accountability, as well as practices associated with the American pluralistic model for democratic accountability. We argue that philanthropic institutions should seek stakeholder and public input when shaping any public policy agenda. This paper suggests a new paradigm, called philanthropic accountability that can be used for legitimacy and democratic governance of private foundations engaged in policy work. The Philanthropic Accountability Model can be empirically tested and used as a governance tool.

  9. Accountable care organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s.

    PubMed

    Burns, Lawton R; Pauly, Mark V

    2012-11-01

    Accountable care organizations are intended to improve the quality and lower the cost of health care through several mechanisms, such as disease management programs, care coordination, and aligning financial incentives for hospitals and physicians. Providers employed several of these mechanisms in forming the integrated delivery networks of the 1990s. The networks failed, however, because of heavy financial losses stemming from hospitals' purchase of physician practices and their inability to align incentives, garner capitated contracts, and develop the infrastructure to manage risk. Although the current mechanisms underlying accountable care organizations continue to evolve, whether and how they will have an impact on quality and costs remains open to question. Care coordination and information technology are proving more complicated and expensive to implement than anticipated, providers may lack the ability to implement these mechanisms, and primary care providers are in short supply. As in the 1990s, success depends on targeting specific populations, such as people with multiple chronic conditions who need and may benefit from coordinated care.

  10. Applying new AICPA accounting rules on special reports.

    PubMed

    Reinstein, A; Dery, R J

    1998-04-01

    Two new standards on agreed-upon procedures, issued by the American Institute of Certified Public Accountants, provide healthcare organizations and associated decision makers with new flexibility in acquiring professional accounting services. Effective January 1, 1996, these procedures allow organizations to target the type and volume of services performed by accountants and potentially avoid the time and expense involved in completing a full financial statement audit. As with any other accounting engagement, both the healthcare organization and the accounting firm need to establish what procedures will be conducted, who will be allowed to use the resulting report, and how the procedures will be conducted.

  11. 49 CFR 1253.10 - Accounts.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Accounts. Accounts shall be kept by each conference, bureau, committee, or other organization subject to... the accounts. All receipts shall be supported by records, including records showing the basis for charges to members. All disbursements shall be supported by vouchers, payrolls, canceled checks, and other...

  12. Implications of new accounting rules for income taxes.

    PubMed

    Reinstein, A; Carmichael, B J; Spaulding, A D

    1994-02-01

    The provisions of the Financial Accounting Standards Board (FASB) Statement No. 109, Accounting for Income Taxes, require all organizations that issue financial statements to shift the focus of their accounting for income taxes from the income statement to the balance sheet. This change can alter significantly a healthcare organization's financial position. The change also may affect the way in which investors, lenders, regulators, and other users of financial statements evaluate corporations in the healthcare industry. Hospitals and other healthcare organizations, particularly for-profit organizations, therefore, should review carefully their methods of accounting for such items as deferred tax assets and loss and expense reserves.

  13. Advantages of fund accounting in 'nonprofits'.

    PubMed

    Herzlinger, R E; Sherman, H D

    1980-01-01

    Motivated by the financial difficulties that have beset city governments and some private nonprofit organizations, the accounting profession and other circles are urging these organizations to conform to business accounting practices. (See Robert N. Anthony's article on p. 83 of this issue.) Fund accounting, these reformers claim, is too complex, too segmented to permit intelligent analysis. The authors of this article demur; not only is it legally and logically necessary to maintain separately the restricted and unrestricted monies received from various sources and spent for designated purposes; also close examination of the financial statements of nonprofit enterprises can provide a very good idea of how well they are doing financially. Furthermore, the authors advocate adoption of certain fund accounting principles for businesses, and they show why they could be helpful. This article is much more than a defense of how nonprofit organizations account for their operations; it is a comprehensive but brief introduction to the subject.

  14. Cost Accounting and Accountability: One Approach.

    ERIC Educational Resources Information Center

    Gingold, William

    This paper outlines an approach designed to provide an accurate and efficient cost accounting system for use in schools and other social service organizations. In his discussion, the author presents a detailed step-by-step description of how to establish, plan, and operate the system. The basic element of the system is the Daily Event Record…

  15. Forum: Is Test-Based Accountability Dead?

    ERIC Educational Resources Information Center

    Polikoff, Morgan S.; Greene, Jay P.; Huffman, Kevin

    2017-01-01

    Since the 2001 passage of the No Child Left Behind Act (NCLB), test-based accountability has been an organizing principle--perhaps "the" organizing principle--of efforts to improve American schools. But lately, accountability has been under fire from many critics, including Common Core opponents and those calling for more multifaceted…

  16. Making sense of nonbusiness accounting.

    PubMed

    Anthony, R N

    1980-01-01

    The nonbusiness world of municipalities, colleges and universities, hospitals, and other nonprofit organizations follows its own rules when it comes to financial statements, and these are often confusing to anyone who is accustomed to business accounting. According to this author, it was the concept of fund accounting that divided the two worlds of business and nonbusiness accounting and led to a situation where it is almost impossible to judge the financial performance of nonbusiness entities. He shows how financial statements of the business and nonbusiness worlds can use the same standards, with a few modifications for the unique features of nonbusiness organizations.

  17. Fiscal Accounting Manual.

    ERIC Educational Resources Information Center

    California State Dept. of Housing and Community Development, Sacramento. Indian Assistance Program.

    Written in simple, easy to understand form, the manual provides a vehicle for the untrained person in bookkeeping to control funds received from grants for Indian Tribal Councils and Indian organizations. The method used to control grants (federal, state, or private) is fund accounting, designed to organize rendering services on a non-profit…

  18. Home and Community Care Sector Accountability

    PubMed Central

    Gray, Carolyn Steele; Berta, Whitney; Deber, Raisa B.; Lum, Janet

    2014-01-01

    This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. PMID:25305389

  19. The role of behavioral health services in accountable care organizations.

    PubMed

    Kathol, Roger G; Patel, Kavita; Sacks, Lee; Sargent, Susan; Melek, Stephen P

    2015-02-01

    Nationally, care delivery organizations are developing accountable care organizations (ACOs), but few have an appreciation of the importance of behavioral health services or knowledge about how to include them in an ACO since their funding and delivery are currently segregated from other medical services. This commentary reviews data on the impact of patients with concurrent medical and behavioral health conditions. They indicate that three-fourths of patients with behavioral health disorders are seen in the medical setting, but are largely untreated because few medical patients choose to access the behavioral health sector, which is where behavioral health providers are paid to work. Untreated behavioral health conditions in medical patients are associated with persistent medical illness and significantly increased total medical healthcare service use and cost, especially in those with chronic medical conditions. At a national level, those with behavioral health conditions use one-third of total healthcare resources. This will not change unless at-risk ACOs can effectively correct the mismatch between behavioral health patients and behavioral healthcare delivery. The authors suggest that ACO subcontracting for traditional segregated behavioral health services, whether from local provider groups or external vendors, will not achieve ACO-mandated access, treatment, and cost reduction goals. Rather, behavioral health specialists will need to become core ACO member providers. This will allow them to be deployed along with other member providers using value-added delivery approaches in the medical setting to integrate medical and behavioral health service delivery, and to achieve synergistic health and cost improvement.

  20. Quality Improvement Strategies in Accountable Care Organization Hospitals.

    PubMed

    Mora, Arthur M; Walker, Daniel

    2016-01-01

    Accountable Care Organizations (ACOs) are hoped to lower costs and improve health care quality. However, hospitals remain unsure how to bring about the quality improvement (QI) required to increase financial viability. This success may hinge on the use of sophisticated measurement tracking and the use of multiple QI tools. This study aims to assess the current approaches that ACO hospitals are using to improve quality and to compare their strategies with non-ACO hospitals. The 2013 American Hospital Association's Annual Survey and the Survey of Care Systems and Payment data were merged to identify ACO and non-ACO hospitals. ACO and non-ACO hospital rates of reported use of multiple QI tools and the ability to detect and track readmissions across organizational boundaries were compared. ACO hospitals were significantly less likely to use only 1 QI tool (43.5% vs 65.2%; P < .001) and more likely to use 2 (36.4% vs 28.1%; P < .05), 3 (12.1% vs 6.5%; P < .001), or 4 (8.0% vs 0.2%; P < .001) QI tools. ACO hospitals were significantly more likely to have the capability to detect readmissions (34.1% vs 22.8%; P < .001) and track readmissions (90.5% vs 85.7%; P < .05). Results suggest that ACO hospitals are incorporating more sophisticated measurements and combinations of QI tools than non-ACO hospitals. It remains to be seen whether this leads to accelerated changes across the quality domains in ACO hospitals.

  1. Consistency endangered by FASB-GASB (Financial Accounting Standards Board, Government Accounting Standards Board ) dispute.

    PubMed

    Garner, M; Grossman, W

    1991-02-01

    The Financial Accounting Foundation's (FAF's) November 1989 decision to uphold the 1984 jurisdictional arrangement between the Financial Accounting Standards Board (FASB) and the Government Accounting Standards Board (GASB) leaves little doubt that the healthcare industry will now be subject to two sets of accounting standards. The FAF's decision created a distinction between the accounting practices of government-owned hospitals and non-hospital governmental entities and their adherence to standards set by FASB, GASB, and the American Institute of Certified Public Accountants. A governmental healthcare organization should carefully determine which accounting rules it follows and remain attentive to further GASB developments.

  2. new lease accounting and health care.

    PubMed

    Berman, Mindy

    2016-05-01

    Recently released lease accounting standards from the Financial Accounting Standards Board (FASB) present three significant challenges for healthcare organizations: All leases must be reported on a company's balance sheet, increasing liabilities on the balance sheets of healthcare organizations considerably. Contractual agreements not previously considered leases will now be treated as leases. Classification of some equipment leases could change.

  3. Home and community care sector accountability.

    PubMed

    Steele Gray, Carolyn; Berta, Whitney; Deber, Raisa B; Lum, Janet

    2014-09-01

    This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care. Copyright © 2014 Longwoods Publishing.

  4. Improving Our Nation's Health Care System: Inclusion of Chiropractic in Patient-Centered Medical Homes and Accountable Care Organizations

    PubMed Central

    Meeker, William C.; Watkins, R.W.; Kranz, Karl C.; Munsterman, Scott D.; Johnson, Claire

    2014-01-01

    Objective This report summarizes the closing plenary session of the Association of Chiropractic Colleges Educational Conference—Research Agenda Conference 2014. The purpose of this session was to examine patient-centered medical homes and accountable care organizations from various speakers’ viewpoints and to discuss how chiropractic could possibly work within, and successfully contribute to, the changing health care environment. Discussion The speakers addressed the complex topic of patient-centered medical homes and accountable care organizations and provided suggestions for what leadership strategies the chiropractic profession may need to enhance chiropractic participation and contribution to improving our nation’s health. Conclusion There are many factors involved in the complex topic of chiropractic inclusion in health care models. Major themes resulting from this panel included the importance of building relationships with other professionals, demonstrating data and evidence for what is done in chiropractic practice, improving quality of care, improving health of populations, and reducing costs of health care. PMID:25431542

  5. Hennepin Health: a safety-net accountable care organization for the expanded Medicaid population.

    PubMed

    Sandberg, Shana F; Erikson, Clese; Owen, Ross; Vickery, Katherine D; Shimotsu, Scott T; Linzer, Mark; Garrett, Nancy A; Johnsrud, Kimry A; Soderlund, Dana M; DeCubellis, Jennifer

    2014-11-01

    Health care payment and delivery models that challenge providers to be accountable for outcomes have fueled interest in community-level partnerships that address the behavioral, social, and economic determinants of health. We describe how Hennepin Health--a county-based safety-net accountable care organization in Minnesota--has forged such a partnership to redesign the health care workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care for an expanded community of Medicaid beneficiaries. Early outcomes suggest that the program has had an impact in shifting care from hospitals to outpatient settings. For example, emergency department visits decreased 9.1 percent between 2012 and 2013, while outpatient visits increased 3.3 percent. An increasing percentage of patients have received diabetes, vascular, and asthma care at optimal levels. At the same time, Hennepin Health has realized savings and reinvested them in future improvements. Hennepin Health offers lessons for counties, states, and public hospitals grappling with the problem of how to make the best use of public funds in serving expanded Medicaid populations and other communities with high needs. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Cluster Guide. Accounting Occupations.

    ERIC Educational Resources Information Center

    Beaverton School District 48, OR.

    Based on a recent task inventory of key occupations in the accounting cluster taken in the Portland, Oregon, area, this curriculum guide is intended to assist administrators and teachers in the design and implementation of high school accounting cluster programs. The guide is divided into four major sections: program organization and…

  7. Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado

    PubMed Central

    McConnell, K. John; Renfro, Stephanie; Chan, Benjamin K.S.; Meath, Thomas H.A.; Mendelson, Aaron; Cohen, Deborah; Waxmonsky, Jeanette; McCarty, Dennis; Wallace, Neal; Lindrooth, Richard C.

    2017-01-01

    Importance A variety of state Medicaid reforms are underway, but the relative performance of different approaches is unclear. Objective To compare performance in Oregon’s and Colorado’s Medicaid Accountable Care Organization (ACO) models. Design, Setting, and Participants Oregon initiated its Medicaid transformation in 2012, supported by a $1.9 billion federal investment, moving the majority of Medicaid enrollees into sixteen Coordinated Care Organizations (CCOs), which managed care within a global budget. Colorado initiated its Medicaid Accountable Care Collaborative (ACC) in 2011, creating seven Regional Care Collaborative Organizations that received funding to coordinate care with providers and connect Medicaid enrollees with community services. We analyzed data spanning July 1, 2010 through December 31, 2014, (18 months pre-intervention and 24 months post intervention, treating 2012 as a transition year) for 452,371 Oregon and 330,511 Colorado Medicaid enrollees, assessing changes in outcomes using difference-in-differences analyses. Exposures Both states emphasized a regional focus, primary care homes, and care coordination. Oregon’s CCO model was more comprehensive in its reform goals and in the imposition of downside financial risk. Main Outcomes and Measures Performance on claims-based measures of standardized expenditures and utilization for selected services, access, preventable hospitalizations, and appropriateness of care. Results Standardized expenditures for selected services declined in both states over the 2010–2014 time period, but these decreases were not significantly different between the two states. Oregon’s model was associated with reductions in emergency department visits (−6.28 per 1000 beneficiary months, 95% CI −10.51 to −2.05) and primary care visits (−15.09 visits per 1000 beneficiary months, 95% CI −26.57 to −3.61), improvements in acute preventable hospital admissions, three out of four measures of access, and

  8. Accountable care organization readiness and academic medical centers.

    PubMed

    Berkowitz, Scott A; Pahira, Jennifer J

    2014-09-01

    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

  9. Accounting for the costs of quality.

    PubMed

    Suver, J D; Neumann, B R; Boles, K E

    1992-09-01

    Total quality management (TQM) represents a paradigm shift in the organizational values that shape every aspect of a healthcare provider's activities. The TQM approach to quality management subscribes to the theory that it is not the work of employees of an organization that leads to poor quality; rather, it is the poor design of systems and procedures. In a book recently published by HFMA, Management Accounting for Healthcare Organizations, third edition, authors Suver, Neumann and Boles point out that the changes in behavioral focus and organizational climate brought about by TQM will have a major impact on management accounting function in healthcare organizations. TQM will require new methods of accounting that will enable the effects of declining quality to be recognized and evaluated. It also will require new types of management accounting reports that will identify opportunities for quality improvement and will monitor the effectiveness of quality management endeavors. The following article has been adapted from the book cited above.

  10. 18 CFR 367.3010 - Account 301, Organization.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... readiness to do business. (b) This account must include the following items: (1) Cost of obtaining certificates authorizing the service company to engage in its business. (2) Fees and expenses for incorporation... discounts upon securities issued or assumed; nor may it include any costs incident to negotiating loans...

  11. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.

    PubMed

    Bao, Yuhua; Casalino, Lawrence P; Pincus, Harold Alan

    2013-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.

  12. Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado.

    PubMed

    McConnell, K John; Renfro, Stephanie; Chan, Benjamin K S; Meath, Thomas H A; Mendelson, Aaron; Cohen, Deborah; Waxmonsky, Jeanette; McCarty, Dennis; Wallace, Neal; Lindrooth, Richard C

    2017-04-01

    Several state Medicaid reforms are under way, but the relative performance of different approaches is unclear. To compare the performance of Oregon's and Colorado's Medicaid Accountable Care Organization (ACO) models. Oregon initiated its Medicaid transformation in 2012, supported by a $1.9 billion investment from the federal government, moving most Medicaid enrollees into 16 Coordinated Care Organizations, which managed care within a global budget. Colorado initiated its Medicaid Accountable Care Collaborative in 2011, creating 7 Regional Care Collaborative Organizations that received funding to coordinate care with providers and connect Medicaid enrollees with community services. Data spanning July 1, 2010, through December 31, 2014 (18 months before intervention and 24 months after intervention, treating 2012 as a transition year) were analyzed for 452 371 Oregon and 330 511 Colorado Medicaid enrollees, assessing changes in outcomes using difference-in-differences analyses of regional focus, primary care homes, and care coordination. Oregon's Coordinated Care Organization model was more comprehensive in its reform goals and in the imposition of downside financial risk. Regional focus, primary care homes, and care coordination in Medicaid ACOs. Performance on claims-based measures of standardized expenditures and utilization for selected services, access, preventable hospitalizations, and appropriateness of care. In a total of 782 882 Medicaid enrollees, 45.0% were male, with mean (SD) age 16.74 (14.41) years. Standardized expenditures for selected services declined in both states during the 2010-2014 period, but these decreases were not significantly different between the 2 states. Oregon's model was associated with reductions in emergency department visits (-6.28 per 1000 beneficiary-months; 95% CI, -10.51 to -2.05) and primary care visits (-15.09 visits per 1000 beneficiary-months; 95% CI, -26.57 to -3.61), improvements in acute preventable hospital

  13. 18 CFR 701.311 - Accounting for disclosures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Accounting for... ORGANIZATION Protection of Privacy § 701.311 Accounting for disclosures. (a) Maintenance of an accounting. (1....303 except § 701.303(c)(1) and (2), an accounting will be made. (2) The accounting will record (i) the...

  14. A taxonomy of hospitals participating in Medicare accountable care organizations.

    PubMed

    Bazzoli, Gloria J; Harless, David W; Chukmaitov, Askar S

    2017-03-03

    Medicare was an early innovator of accountable care organizations (ACOs), establishing the Medicare Shared Savings Program (MSSP) and Pioneer programs in 2012-2013. Existing research has documented that ACOs bring together an array of health providers with hospitals serving as important participants. Hospitals vary markedly in their service structure and organizational capabilities, and thus, one would expect hospital ACO participants to vary in these regards. Our research identifies hospital subgroups that share certain capabilities and competencies. Such research, in conjunction with existing ACO research, provides deeper understanding of the structure and operation of these organizations. Given that Medicare was an initiator of the ACO concept, our findings provide a baseline to track the evolution of ACO hospitals over time. Hierarchical clustering methods are used in separate analyses of MSSP and Pioneer ACO hospitals. Hospitals participating in ACOs with 2012-2013 start dates are identified through multiple sources. Study data come from the Centers for Medicare and Medicaid Services, American Hospital Association, and Health Information and Management Systems Society. Five-cluster solutions were developed separately for the MSSP and Pioneer hospital samples. Both the MSSP and Pioneer taxonomies had several clusters with high levels of health information technology capabilities. Also distinct clusters with strong physician linkages were present. We examined Pioneer ACO hospitals that subsequently left the program and found that they commonly had low levels of ambulatory care services or health information technology. Distinct subgroups of hospitals exist in both the MSSP and Pioneer programs, suggesting that individual hospitals serve different roles within an ACO. Health information technology and physician linkages appear to be particularly important features in ACO hospitals. ACOs need to consider not only geographic and service mix when selecting hospital

  15. Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

    PubMed Central

    Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

    2012-01-01

    Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools – accountability measures and payment designs – to improve access to and quality of care for patients with behavioral health needs. PMID:23188486

  16. Implementing Accountable Care Organizations: Lessons From a Qualitative Analysis of Four Private Sector Organizations.

    PubMed

    Walker, Daniel M; Hefner, Jennifer L; Sova, Lindsey N; Hilligoss, Brian; Song, Paula H; McAlearney, Ann Scheck

    Accountable care organizations (ACOs) are emerging across the healthcare marketplace and now include Medicare, Medicaid, and private sector payers covering more than 24 million lives. However, little is known about the process of organizational change required to achieve cost savings and quality improvements from the ACO model. This study applies the complex innovation implementation framework to understand the challenges and facilitators associated with the ACO implementation process. We conducted four case studies of private sector ACOs, selected to achieve variation in terms of geography and organizational maturity. Across sites, we used semistructured interviews with 68 key informants to elicit information regarding ACO implementation. Our analysis found challenges and facilitators across all domains in the conceptual framework. Notably, our findings deviated from the framework in two ways. First, findings from the financial resource availability domain revealed both financial and nonfinancial (i.e., labor) resources that contributed to implementation effectiveness. Second, a new domain, patient engagement, emerged as an important factor in implementation effectiveness. We present these deviations in an adapted framework. As the ACO model proliferates, these findings can support implementation efforts, and they highlight the importance of focusing on patients throughout the process. Importantly, this study extends the complex innovation implementation framework to incorporate consumers into the implementation framework, making it more patient centered and aiding future efforts.

  17. The OECD as Pivot of the Emerging Global Educational Accountability Regime: How Accountable Are the Accountants?

    ERIC Educational Resources Information Center

    Meyer, Heinz-Dieter

    2014-01-01

    Background/Context: PISA has catapulted the OECD- an organization whose mission is the global growth of market economies-to a central role in international education policy making, rivaling and sometimes outdoing the various national governments in influence. While claiming scientific evidence as the basis for the accountability regime it…

  18. Growth of Accountable Care Organizations in California: Number, Characteristics, and State Regulation.

    PubMed

    Fulton, Brent D; Pegany, Vishaal; Keolanui, Beth; Scheffler, Richard M

    2015-08-01

    Accountable care organizations (ACOs) result in physician organizations' and hospitals' receiving risk-based payments tied to costs, health care quality, and patient outcomes. This article (1) describes California ACOs within Medicare, the commercial market, and Medi-Cal and the safety net; (2) discusses how ACOs are regulated by the California Department of Managed Health Care and the California Department of Insurance; and (3) analyzes the increase of ACOs in California using data from Cattaneo and Stroud. While ACOs in California are well established within Medicare and the commercial market, they are still emerging within Medi-Cal and the safety net. Notwithstanding, the state has not enacted a law or issued a regulation specific to ACOs; they are regulated under existing statutes and regulations. From August 2012 to February 2014, the number of lives covered by ACOs increased from 514,100 to 915,285, representing 2.4 percent of California's population, including 10.6 percent of California's Medicare fee-for-service beneficiaries and 2.3 percent of California's commercially insured lives. By emphasizing health care quality and patient outcomes, ACOs have the potential to build and improve on California's delegated model. If recent trends continue, ACOs will have a greater influence on health care delivery and financial risk sharing in California. Copyright © 2015 by Duke University Press.

  19. Implications of Accounting Practice for Financial Analysis.

    ERIC Educational Resources Information Center

    Wilkinson, William M.

    1979-01-01

    Different kinds of financial data are needed by different levels of management and in different areas of support. Accounting principles for nonprofit organizations need to be determined. Accrual accounting principles, fund accounting, restricted and unrestricted funds, etc., are described. (MLW)

  20. Emerging accounting trends accounting for leases.

    PubMed

    Valletta, Robert; Huggins, Brian

    2010-12-01

    A new model for lease accounting can have a significant impact on hospitals and healthcare organizations. The new approach proposes a "right-of-use" model that involves complex estimates and significant administrative burden. Hospitals and health systems that draw heavily on lease arrangements should start preparing for the new approach now even though guidance and a final rule are not expected until mid-2011. This article highlights a number of considerations from the lessee point of view.

  1. Consideration of social values in the establishment of accountable care organizations in the USA.

    PubMed

    Keren, Ron; Littlejohns, Peter

    2012-01-01

    The purpose of this paper is to introduce the new US health organizations called accountable care organizations (ACOs) which are expected to improve the quality and reduce the cost of healthcare for Medicare enrolees. It assesses the importance of ACOs, defining and articulating the values that will underpin their strategic and clinical decision making. This paper uses a social values framework developed by Clark and Weale to consider the values relevant to ACOs. It is likely that social values could be made more explicit in a US setting than they have ever been before, via the new ACOs. Social values could start to form part of a local health economy's marketing strategy. ACOs are very new. This paper identifies that they will need to be very explicit about the values relevant to them. The development of ACOs and the articulation of social values therein may even form the basis of a meaningful dialogue on the importance of assessing value for money or cost-effectiveness in the wider US health policy environment.

  2. Proximal sensing for soil carbon accounting

    NASA Astrophysics Data System (ADS)

    England, Jacqueline R.; Viscarra Rossel, Raphael A.

    2018-05-01

    Maintaining or increasing soil organic carbon (C) is vital for securing food production and for mitigating greenhouse gas (GHG) emissions, climate change, and land degradation. Some land management practices in cropping, grazing, horticultural, and mixed farming systems can be used to increase organic C in soil, but to assess their effectiveness, we need accurate and cost-efficient methods for measuring and monitoring the change. To determine the stock of organic C in soil, one requires measurements of soil organic C concentration, bulk density, and gravel content, but using conventional laboratory-based analytical methods is expensive. Our aim here is to review the current state of proximal sensing for the development of new soil C accounting methods for emissions reporting and in emissions reduction schemes. We evaluated sensing techniques in terms of their rapidity, cost, accuracy, safety, readiness, and their state of development. The most suitable method for measuring soil organic C concentrations appears to be visible-near-infrared (vis-NIR) spectroscopy and, for bulk density, active gamma-ray attenuation. Sensors for measuring gravel have not been developed, but an interim solution with rapid wet sieving and automated measurement appears useful. Field-deployable, multi-sensor systems are needed for cost-efficient soil C accounting. Proximal sensing can be used for soil organic C accounting, but the methods need to be standardized and procedural guidelines need to be developed to ensure proficient measurement and accurate reporting and verification. These are particularly important if the schemes use financial incentives for landholders to adopt management practices to sequester soil organic C. We list and discuss requirements for developing new soil C accounting methods based on proximal sensing, including requirements for recording, verification, and auditing.

  3. Accounting for natural organic matter in aqueous chemical equilibrium models: a review of the theories and applications

    NASA Astrophysics Data System (ADS)

    Dudal, Yves; Gérard, Frédéric

    2004-08-01

    Soil organic matter consists of a highly complex and diversified blend of organic molecules, ranging from low molecular weight organic acids (LMWOAs), sugars, amines, alcohols, etc., to high apparent molecular weight fulvic and humic acids. The presence of a wide range of functional groups on these molecules makes them very reactive and influential in soil chemistry, in regards to acid-base chemistry, metal complexation, precipitation and dissolution of minerals and microbial reactions. Out of these functional groups, the carboxylic and phenolic ones are the most abundant and most influential in regards to metal complexation. Therefore, chemical equilibrium models have progressively dealt with organic matter in their calculations. This paper presents a review of six chemical equilibrium models, namely N ICA-Donnan, E Q3/6, G EOCHEM, M INTEQA2, P HREEQC and W HAM, in light of the account they make of natural organic matter (NOM) with the objective of helping potential users in choosing a modelling approach. The account has taken various faces, mainly by adding specific molecules within the existing model databases (E Q3/6, G EOCHEM, and P HREEQC) or by using either a discrete (W HAM) or a continuous (N ICA-Donnan and M INTEQA2) distribution of the deprotonated carboxylic and phenolic groups. The different ways in which soil organic matter has been integrated into these models are discussed in regards to the model-experiment comparisons that were found in the literature, concerning applications to either laboratory or natural systems. Much of the attention has been focused on the two most advanced models, W HAM and N ICA-Donnan, which are able to reasonably describe most of the experimental results. Nevertheless, a better knowledge of the humic substances metal-binding properties is needed to better constrain model inputs with site-specific parameter values. This represents the main axis of research that needs to be carried out to improve the models. In addition to

  4. An overview of accounting and budgeting.

    PubMed

    Cawein, C

    2001-01-01

    Accounting is inextricably linked with daily professional practice and commerce. No individual, organization, or business can survive without some understanding of the basic concepts of accounting. Having knowledge of fundamental concepts of accounting will relieve some of the pressures imposed by governmental regulatory agencies and legislative requirements, and assist healthcare workers in operating more effectively and competing more successfully.

  5. Government Accounting Standards: Past, Present and Future.

    ERIC Educational Resources Information Center

    Harmer, W. Gary

    1993-01-01

    States that government accounting is the product of mixing together budget-oriented and accounting-oriented voices. Presents a history of governmental accounting including the groups involved. An organization chart describes the current standard-setting structure. Accomplishments that improve reporting operations results are listed. (MLF)

  6. Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

    PubMed

    Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

    2015-01-01

    Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. © The Author(s) 2015.

  7. Medicare Accountable Care Organizations of Diverse Structures Achieve Comparable Quality and Cost Performance.

    PubMed

    Comfort, Leeann N; Shortell, Stephen M; Rodriguez, Hector P; Colla, Carrie H

    2018-01-31

    To examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) is associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). Three waves of the National Survey of ACOs and corresponding publicly available Centers for Medicare & Medicaid Services performance data for NSACO respondents participating in the MSSP (N = 204); SK&A Office Based Physicians Database from QuintilesIMS. We compare the performance of three ACO types (physician-led, integrated, and hybrid) for three domains: quality, spending, and likelihood of achieving savings. Sources of performance variation within and between ACO types are compared for each performance measure. There is greater heterogeneity within ACO types than between ACO types. There were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year. There was evidence for higher spending on physician services for physician-led ACOs. ACOs of diverse structures perform comparably on core MSSP quality and spending measures. CMS should maintain its flexibility and continue to support participation of diverse ACOs. Future research to identify modifiable organizational factors that account for performance variation within ACO types may provide insight as to how best to improve ACO performance based on organizational structure and ownership. © Health Research and Educational Trust.

  8. Redesigning Care Delivery with Patient Support Personnel: Learning from Accountable Care Organizations

    PubMed Central

    Gorbenko, Ksenia O.; Fraze, Taressa; Lewis, Valerie A.

    2017-01-01

    INTRODUCTION Accountable care organizations (ACOs) are a value-based payment model in the United States rooted in holding groups of healthcare providers financially accountable for the quality and total cost of care of their attributed population. To succeed in reaching their quality and efficiency goals, ACOs implement a variety of care delivery changes, including workforce redesign. Patient support personnel (PSP)—non-physician staff such as care coordinators, community health workers, and others—are critical to restructuring care delivery. Little is known about how ACOs are redesigning their patient support personnel in terms of responsibilities, location, and evaluation. METHODS We conducted semi-structured one-hour interviews with 25 executives at 16 distinct ACOs. The interviews were recorded, transcribed, and coded for themes, using a qualitative coding and analysis process. RESULTS ACOs deployed PSP to perform four clusters of responsibilities: care provision, care coordination, logistical help with transportation, and social and emotional support. ACOs deployed these personnel strategically across settings (primary care, inpatient services, emergency department, home care and community) depending on their population needs. Most ACOs used personnel with the same level of training across settings. Few ACOs planned to conduct a comprehensive evaluation of their PSP to optimize their value. DISCUSSION ACO strategies in workforce redesign indicate a shift from a physician-centered to a team-based approach. Employing personnel with varying levels of clinical training to perform different tasks can help further optimize care delivery. More robust evaluation of the deployment of PSP and their performance is needed to demonstrate cost-saving benefits of workforce redesign. PMID:28217305

  9. Improving Care Transitions Management: Examining the Role of Accountable Care Organization Participation and Expanded Electronic Health Record Functionality.

    PubMed

    Huber, Thomas P; Shortell, Stephen M; Rodriguez, Hector P

    2017-08-01

    Examine the extent to which physician organization participation in an accountable care organization (ACO) and electronic health record (EHR) functionality are associated with greater adoption of care transition management (CTM) processes. A total of 1,398 physician organizations from the third National Study of Physician Organization survey (NSPO3), a nationally representative sample of medical practices in the United States (January 2012-May 2013). We used data from the third National Study of Physician Organization survey (NSPO3) to assess medical practice characteristics, including CTM processes, ACO participation, EHR functionality, practice type, organization size, ownership, public reporting, and pay-for-performance participation. Multivariate linear regression models estimated the extent to which ACO participation and EHR functionality were associated with greater CTM capabilities, controlling for practice size, ownership, public reporting, and pay-for-performance participation. Approximately half (52.4 percent) of medical practices had a formal program for managing care transitions in place. In adjusted analyses, ACO participation (p < .001) and EHR functionality (p < .001) were independently associated with greater use of CTM processes among medical practices. The growth of ACOs and similar provider risk-bearing arrangements across the country may improve the management of care transitions by physician organizations. © Health Research and Educational Trust.

  10. Teaching What Matters: A New Conception of Accounting Education

    ERIC Educational Resources Information Center

    Hurt, Bob

    2007-01-01

    Various accounting professional organizations, such as the American Institute of Certified Public Accountants and the Institute of Management Accountants, have issued repeated calls for change in accounting education. However, few groups have consulted accounting academics about the purpose, structure, or content of the accounting curriculum. In…

  11. 18 CFR 701.311 - Accounting for disclosures.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Accounting for disclosures. 701.311 Section 701.311 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Protection of Privacy § 701.311 Accounting for disclosures. (a) Maintenance of an accounting. (1...

  12. 18 CFR 701.311 - Accounting for disclosures.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Accounting for disclosures. 701.311 Section 701.311 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Protection of Privacy § 701.311 Accounting for disclosures. (a) Maintenance of an accounting. (1...

  13. 18 CFR 701.311 - Accounting for disclosures.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Accounting for disclosures. 701.311 Section 701.311 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Protection of Privacy § 701.311 Accounting for disclosures. (a) Maintenance of an accounting. (1...

  14. 18 CFR 701.311 - Accounting for disclosures.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Accounting for disclosures. 701.311 Section 701.311 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Protection of Privacy § 701.311 Accounting for disclosures. (a) Maintenance of an accounting. (1...

  15. Performance Differences in Year 1 of Pioneer Accountable Care Organizations

    PubMed Central

    McWilliams, J. Michael; Chernew, Michael E.; Landon, Bruce E.; Schwartz, Aaron L.

    2015-01-01

    BACKGROUND In 2012, a total of 32 organizations entered the Pioneer accountable care organization (ACO) program, in which providers can share savings with Medicare if spending falls below a financial benchmark. Performance differences associated with characteristics of Pioneer ACOs have not been well described. METHODS In a difference-in-differences analysis of Medicare fee-for-service claims, we compared Medicare spending for beneficiaries attributed to Pioneer ACOs (ACO group) with other beneficiaries (control group) before (2009 through 2011) and after (2012) the start of Pioneer ACO contracts, with adjustment for geographic area and beneficiaries’ sociodemographic and clinical characteristics. We estimated differential changes in spending for several subgroups of ACOs: those with and those without clear financial integration between hospitals and physician groups, those with higher and those with lower baseline spending, and the 13 ACOs that withdrew from the Pioneer program after 2012 and the 19 that did not. RESULTS Adjusted Medicare spending and spending trends were similar in the ACO group and the control group during the precontract period. In 2012, the total adjusted per-beneficiary spending differentially changed in the ACO group as compared with the control group (−$29.2 per quarter, P = 0.007), consistent with a 1.2% savings. Savings were significantly greater for ACOs with baseline spending above the local average, as compared with those with baseline spending below the local average (P = 0.05 for interaction), and for those serving high-spending areas, as compared with those serving low-spending areas (P = 0.04). Savings were similar in ACOs with financial integration between hospitals and physician groups and those without, as well as in ACOs that withdrew from the program and those that did not. CONCLUSIONS Year 1 of the Pioneer ACO program was associated with modest reductions in Medicare spending. Savings were greater for ACOs with higher

  16. Accounting Programs' Home Pages: What's Happening.

    ERIC Educational Resources Information Center

    Peek, Lucia E.; Roxas, Maria L.

    2002-01-01

    Content analysis of 62 accounting programs' websites indicated the following: 53% include mission statements; 62.9% list accreditation; many faculty biographies and personal pages used inconsistent formats; provision of information on financial aid, student organizations, career services, and certified public accountant requirements varied. Many…

  17. Future Performance Trend Indicators: A Current Value Approach to Human Resources Accounting. Report II: Internal Consistencies and Relationships to Performance in Organization VI. Technical Report.

    ERIC Educational Resources Information Center

    Pecorella, Patricia A.; Bowers, David G.

    Conventional accounting systems provide no indication as to what conditions and events lead to reported outcomes, since they traditionally do not include measurements of the human organization and its relationship to events at the outcome stage. Human resources accounting is used to measure these additional types of data. This research is…

  18. Combining accounting approaches to practice valuation.

    PubMed

    Schwartzben, D; Finkler, S A

    1998-06-01

    Healthcare organizations that wish to acquire physician or ambulatory care practices can choose from a variety of practice valuation approaches. Basic accounting methods assess the value of a physician practice on the basis of a historical, balance-sheet description of tangible assets. Yet these methods alone are inadequate to determine the true financial value of a practice. By using a combination of accounting approaches to practice valuation that consider factors such as fair market value, opportunity cost, and discounted cash flow over a defined time period, organizations can more accurately assess a practice's actual value.

  19. Early Performance of Accountable Care Organizations in Medicare

    PubMed Central

    McWilliams, J. Michael; Hatfield, Laura A.; Chernew, Michael E.; Landon, Bruce E.; Schwartz, Aaron L.

    2016-01-01

    BACKGROUND In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs. METHODS Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent ACO contracting with commercial insurers. RESULTS Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was −$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P = 0.02), consistent with a 1.4% savings, but only −$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P = 0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P = 0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others. CONCLUSIONS The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in

  20. A framework for evaluating the formation, implementation, and performance of accountable care organizations.

    PubMed

    Fisher, Elliott S; Shortell, Stephen M; Kreindler, Sara A; Van Citters, Aricca D; Larson, Bridget K

    2012-11-01

    The implementation of accountable care organizations (ACOs), a new health care payment and delivery model designed to improve care and lower costs, is proceeding rapidly. We build on our experience tracking early ACOs to identify the major factors-such as contract characteristics; structure, capabilities, and activities; and local context-that would be likely to influence ACO formation, implementation, and performance. We then propose how an ACO evaluation program could be structured to guide policy makers and payers in improving the design of ACO contracts, while providing insights for providers on approaches to care transformation that are most likely to be successful in different contexts. We also propose key activities to support evaluation of ACOs in the near term, including tracking their formation, developing a set of performance measures across all ACOs and payers, aggregating those performance data, conducting qualitative and quantitative research, and coordinating different evaluation activities.

  1. Early impact of Medicare accountable care organizations on cancer surgery outcomes.

    PubMed

    Herrel, Lindsey A; Norton, Edward C; Hawken, Scott R; Ye, Zaojun; Hollenbeck, Brent K; Miller, David C

    2016-09-01

    Accountable care organizations (ACOs) were established to improve care and outcomes for beneficiaries requiring highly coordinated, complex care. The objective of this study was to evaluate the association between hospital ACO participation and the outcomes of major surgical oncology procedures. This was a retrospective cohort study of Medicare beneficiaries older than 65 years who were undergoing a major surgical resection for colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer from 2011 through 2013. A difference-in-differences analysis was implemented to compare the postimplementation period (January 2013 through December 2013) with the baseline period (January 2011 through December 2012) to assess the impact of hospital ACO participation on 30-day mortality, complications, readmissions, and length of stay (LOS). Among 384,519 patients undergoing major cancer surgery at 106 ACO hospitals and 2561 control hospitals, this study found a 30-day mortality rate of 3.4%, a readmission rate of 12.5%, a complication rate of 43.8%, and a prolonged LOS rate of 10.0% in control hospitals and similar rates in ACO hospitals. Secular trends were noted, with reductions in perioperative adverse events in control hospitals between the baseline and postimplementation periods: mortality (percentage-point reduction, 0.1%; P = .19), readmissions (percentage-point reduction, 0.4%; P = .001), complications (percentage-point reduction, 1.0%; P < .001), and prolonged LOS (percentage-point reduction, 1.1%; P < .001). After accounting for these secular trends, this study identified no significant effect of hospital participation in an ACO on the frequency of perioperative outcomes (difference-in-differences estimator P values, .24-.72). Early hospital participation in the Medicare Shared Savings Program ACO program was not associated with greater reductions in adverse perioperative outcomes for patients undergoing major cancer

  2. Methods development for total organic carbon accountability

    NASA Technical Reports Server (NTRS)

    Benson, Brian L.; Kilgore, Melvin V., Jr.

    1991-01-01

    This report describes the efforts completed during the contract period beginning November 1, 1990 and ending April 30, 1991. Samples of product hygiene and potable water from WRT 3A were supplied by NASA/MSFC prior to contract award on July 24, 1990. Humidity condensate samples were supplied on August 3, 1990. During the course of this contract chemical analyses were performed on these samples to qualitatively determine specific components comprising, the measured organic carbon concentration. In addition, these samples and known standard solutions were used to identify and develop methodology useful to future comprehensive characterization of similar samples. Standard analyses including pH, conductivity, and total organic carbon (TOC) were conducted. Colorimetric and enzyme linked assays for total protein, bile acid, B-hydroxybutyric acid, methylene blue active substances (MBAS), urea nitrogen, ammonia, and glucose were also performed. Gas chromatographic procedures for non-volatile fatty acids and EPA priority pollutants were also performed. Liquid chromatography was used to screen for non-volatile, water soluble compounds not amenable to GC techniques. Methods development efforts were initiated to separate and quantitate certain chemical classes not classically analyzed in water and wastewater samples. These included carbohydrates, organic acids, and amino acids. Finally, efforts were initiated to identify useful concentration techniques to enhance detection limits and recovery of non-volatile, water soluble compounds.

  3. The Role of Social Work Leadership: Mount Sinai Care, the Accountable Care Organization, and Population Health Management.

    PubMed

    Xenakis, Nancy

    2015-10-01

    In July 2012, The Mount Sinai Medical Center was selected by the Centers for Medicare and Medicaid to join the first cohort of Accountable Care Organizations (ACOs) in this country under its Medicare Shared Savings Program. A critical component of an ACO is care coordination of patients, which is a complex concept, intertwined with other concepts related to quality, delivery and organization of health care. This article provides an overview of the development, structure and functionality of Mount Sinai Care, the ACO of The Mount Sinai Health System, and how it was the beginning of its work in population health management. It describes the important role of social work leadership in the development and operation of its care coordination model. The model's successes and challenges and recommendations for future development of care coordination and population health management are outlined.

  4. Evaluating Innovations in Home Care for Performance Accountability.

    PubMed

    Collister, Barbara; Gutscher, Abram; Ambrogiano, Jana

    2016-01-01

    Concerns about rising costs and the sustainability of our healthcare system have led to a drive for innovative solutions and accountability for performance. Integrated Home Care, Calgary Zone, Alberta Health Services went beyond traditional accountability measures to use evaluation methodology to measure the progress of complex innovations to its organization structure and service delivery model. This paper focuses on the first two phases of a three-phase evaluation. The results of the first two phases generated learning about innovation adoption and sustainability, and performance accountability at the program-level of a large publicly funded healthcare organization.

  5. Accounting for Results: How Conservation Organizations Report Performance Information

    NASA Astrophysics Data System (ADS)

    Rissman, Adena R.; Smail, Robert

    2015-04-01

    Environmental program performance information is in high demand, but little research suggests why conservation organizations differ in reporting performance information. We compared performance measurement and reporting by four private-land conservation organizations: Partners for Fish and Wildlife in the US Fish and Wildlife Service (national government), Forest Stewardship Council—US (national nonprofit organization), Land and Water Conservation Departments (local government), and land trusts (local nonprofit organization). We asked: (1) How did the pattern of performance reporting relationships vary across organizations? (2) Was political conflict among organizations' principals associated with greater performance information? and (3) Did performance information provide evidence of program effectiveness? Based on our typology of performance information, we found that most organizations reported output measures such as land area or number of contracts, some reported outcome indicators such as adherence to performance standards, but few modeled or measured environmental effects. Local government Land and Water Conservation Departments reported the most types of performance information, while local land trusts reported the fewest. The case studies suggest that governance networks influence the pattern and type of performance reporting, that goal conflict among principles is associated with greater performance information, and that performance information provides unreliable causal evidence of program effectiveness. Challenging simple prescriptions to generate more data as evidence, this analysis suggests (1) complex institutional and political contexts for environmental program performance and (2) the need to supplement performance measures with in-depth evaluations that can provide causal inferences about program effectiveness.

  6. Accounting for results: how conservation organizations report performance information.

    PubMed

    Rissman, Adena R; Smail, Robert

    2015-04-01

    Environmental program performance information is in high demand, but little research suggests why conservation organizations differ in reporting performance information. We compared performance measurement and reporting by four private-land conservation organizations: Partners for Fish and Wildlife in the US Fish and Wildlife Service (national government), Forest Stewardship Council-US (national nonprofit organization), Land and Water Conservation Departments (local government), and land trusts (local nonprofit organization). We asked: (1) How did the pattern of performance reporting relationships vary across organizations? (2) Was political conflict among organizations' principals associated with greater performance information? and (3) Did performance information provide evidence of program effectiveness? Based on our typology of performance information, we found that most organizations reported output measures such as land area or number of contracts, some reported outcome indicators such as adherence to performance standards, but few modeled or measured environmental effects. Local government Land and Water Conservation Departments reported the most types of performance information, while local land trusts reported the fewest. The case studies suggest that governance networks influence the pattern and type of performance reporting, that goal conflict among principles is associated with greater performance information, and that performance information provides unreliable causal evidence of program effectiveness. Challenging simple prescriptions to generate more data as evidence, this analysis suggests (1) complex institutional and political contexts for environmental program performance and (2) the need to supplement performance measures with in-depth evaluations that can provide causal inferences about program effectiveness.

  7. Accountability, efficiency, and the "bottom line" in non-profit organizations.

    PubMed

    Cutt, J

    1982-01-01

    Financial reporting by non-profit organizations deals only with accountability for propriety and regularity, and ignores output measurement. The development of output measures of a physical or index nature offers a means of relating dollar costs to output in the form of cost-efficiency or cost-effectiveness measures, but does not provide any measure of the absolute value or worthwhileness of such programs. This fundamental absolute value question should be asked of all non-profit programs and documented to the greatest possible extent in budgetary submissions, and subsequent control and audit. In public sector non-profit programs, the posing of this question requires information on consumer demand other than in aggregative and imprecise form through the political process, and much improved information on the cost side. Eliciting demand information is feasible in the case of public programs with separable benefits by the use of a variety of pricing techniques, direct or imputed, whether or not the service in question is ultimately financed on a user-pay basis. The problem of eliciting demand is more difficult in the case of public goods, but improved demand information can be obtained, ideally by an approach such as the use of a Clarke tax. The argument can be extended to encompass questions of income distribution, stabilization, regulation and tax policy. Recent developments in program evaluation in the federal government are important, but remain deficient in failing to address the question of absolute value.

  8. Factory approach can streamline patient accounting.

    PubMed

    Rands, J; Muench, M

    1991-08-01

    Although they may seem fundamentally different, similarities exist between operations of factories and healthcare organizations' business offices. As a result, a patient accounting approach based on manufacturing firms' management techniques may help smooth healthcare business processes. Receivables performance management incorporates the Japanese techniques of "just-in-time" and total quality management to reduce unbilled accounts and information backlog and accelerate payment. A preliminary diagnostic assessment of a patient accounting process helps identify bottlenecks and set priorities for work flow.

  9. 48 CFR 31.201-6 - Accounting for unallowable costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Accounting for unallowable... Organizations 31.201-6 Accounting for unallowable costs. (a) Costs that are expressly unallowable or mutually... accounting for and presentation of unallowable costs must be those described in 48 CFR 9904.405, Accounting...

  10. Moving toward implementation: the potential for accountable care organizations and private-public partnerships to advance active neighborhood design.

    PubMed

    Zusman, Edie E; Carr, Sara Jensen; Robinson, Judy; Kasirye, Olivia; Zell, Bonnie; Miller, William Jahmal; Duarte, Teri; Engel, Adrian B; Hernandez, Monica; Horton, Mark B; Williams, Frank

    2014-12-01

    The 2010 Affordable Care Act's (ACA) aims of lowering costs and improving quality of care will renew focus on preventive health strategies. This coincides with a trend in medicine to reconsider population health approaches as part of the standard curriculum. This intersection of new policy and educational climates presents a unique opportunity to reconsider traditional healthcare structures. This paper introduces and advances an alignment that few have considered. We propose that accountable care organizations (ACOs), which are expected to proliferate under the ACA, present the best opportunity to establish partnerships between healthcare, public health, and community-based organizations to achieve the legislation's goals. One example is encouraging daily physical activity via built environment interventions and programs, which is recommended by numerous groups. We highlight how nonprofit organizations in Sacramento, California have been able to leverage influence, capital, and policy to encourage design for active living, and how their work is coordinating with public health and healthcare initiatives. In conclusion, we critically examine potential barriers to the success of partnerships between ACOs and community organizations and encourage further exploration and evaluation. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Early experience of a safety net provider reorganizing into an accountable care organization.

    PubMed

    Hacker, Karen; Santos, Palmira; Thompson, Douglas; Stout, Somava S; Bearse, Adriana; Mechanic, Robert E

    2014-08-01

    Although safety net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge Health Alliance (CHA) in Massachusetts, where health care reform began six years ago, provides insight into the opportunities and challenges of this approach in the safety net. CHA's strategies include care redesign, financial realignment, workforce transformation, and development of external partnerships. Early results show some improvement in access, patient experience, quality, and utilization; however, the potential efficiencies will not eliminate CHA's current operating deficit. The patient population, payer mix, service mix, cost structure, and political requirements reduce the likelihood of financial sustainability without significant changes in these factors, increased public funding, or both. Thus the future of safety net institutions, regardless of payment and care redesign success, remains at risk. Copyright © 2014 by Duke University Press.

  12. New Hampshire Nurse Practitioners Take the Lead in Forming an Accountable Care Organization.

    PubMed

    Wright, Wendy L

    In 2012, New Hampshire nurse practitioners (NPs), along with Anthem Blue Cross/Blue Shield, formed the first Patient Centered Shared Savings Program in the nation, composed of patients managed by nurse practitioners employed within NP-owned and operated clinics. In this accountable care organization (ACO), NP-attributed patients were grouped into one risk pool. Data from the ACO and the NP risk pool, now in its third year, have produced compelling statistics. Nurse practitioners participating in this program have met or exceeded the minimum scores for 29 quality metrics along with a demonstrated cost-savings in the first 2 years of the program. Hospitalization rates for NP-managed patients are among the lowest in the state. Cost of care for NP-managed patients is $66.85 less per member per month than the participating physician-managed patients. Data from this ACO provide evidence that NPs provide cost-effective, quality health care and are integral to the formation and sustainability of any ACO.

  13. Accountable care organization hospitals differ in health IT capabilities.

    PubMed

    Walker, Daniel M; Mora, Arthur M; Scheck McAlearney, Ann

    2016-12-01

    The aim of this study was to evaluate health information technology (IT) adoption in hospitals participating in accountable care organizations (ACOs) and compare this adoption to non-ACO hospitals. A cross-sectional sample of US nonfederal, acute care hospitals with data from 3 matched sources: the 2013 American Hospital Association (AHA) Annual Survey, the 2013 AHA Survey of Care Systems and Payments (CSP), and the 2014 AHA Information Technology Supplement. To compare health IT adoption in ACO- and non-ACO hospitals, we created measures of Meaningful Use (MU) Stage 1 and Stage 2 core and menu criteria, patient engagement-oriented health IT, and health information exchange (HIE) participation. Adoption was compared using both naïve and multivariate logit models. Of the 393 ACO hospitals and 810 non-ACO hospitals, a greater percentage of ACO hospitals were capable of meeting MU Stage 1 (50.9% vs 41.6%; P < .01) and Stage 2 (7.6% vs 4.8%; P < .05), having patient engagement health IT (39.8% vs 15.2%; P < .001), and participating in HIE (49.0% vs 30.1%; P < .001). In adjusted models, no difference was found between ACO and non-ACO hospital ability to meet MU Stage 1 or Stage 2, but ACO hospitals were more likely to have patient engagement health IT (odds ratio (OR), 2.20; 95% CI, 1.59-3.04) and be HIE participants (OR, 1.41; 95% CI, 1.03-1.92). ACO-participating hospitals appear to be focused more on adopting health IT that aligns with broader strategic goals rather than those that achieve MU. Aligning adoption with quality and payment reform may be a productive path forward to encourage hospital health IT adoption behavior.

  14. A primary estimate of global PCDD/F release based on the quantity and quality of national economic and social activities.

    PubMed

    Wang, Bin; Fiedler, Heidelore; Huang, Jun; Deng, Shubo; Wang, Yujue; Yu, Gang

    2016-05-01

    The correlations between polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) releases and factors relevant to human social-economic activities (HSEAs) were analyzed. The multiple linear regression model was successfully developed to estimate the total global PCDD/F release. The PCDD/F releases significantly correlated with population, area, GDP and GNI, suggesting that "quantity" of HSEAs have significantly contributed to the PCDD/F releases. On another aspect, advanced technologies are usually adopted in developed countries/regions, and hence reduce the PCDD/F release. The significant correlation between PCDD/F release and CO2 emission implies the potential of simultaneous reduction of CO2 emission and PCDD/F release. The total global PCDD/F release from 196 countries/regions was estimated to be 100.4 kg-TEQ yr(-1). The estimated annual PCDD/F release per unit area ranged from 0.007 to 28 mg-TEQ km(-2). Asia is estimated to have the highest PCDD/F release of 47.1 kg-TEQ yr(-1), almost half of the total world release. Oceania is estimated to have the smallest total release but the largest per-capita release. For the developed areas, such as Europe and North America, the PCDD/F release per unit GDP is lower, while for Africa, it is much higher. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. 5 CFR 950.203 - Public accountability standards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... PRIVATE VOLUNTARY ORGANIZATIONS Eligibility Provisions § 950.203 Public accountability standards. (a) To insure organizations wishing to solicit donations from Federal employees in the workplace are portraying... Section 950.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE...

  16. 5 CFR 950.203 - Public accountability standards.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... PRIVATE VOLUNTARY ORGANIZATIONS Eligibility Provisions § 950.203 Public accountability standards. (a) To insure organizations wishing to solicit donations from Federal employees in the workplace are portraying... Section 950.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE...

  17. 5 CFR 950.203 - Public accountability standards.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... PRIVATE VOLUNTARY ORGANIZATIONS Eligibility Provisions § 950.203 Public accountability standards. (a) To insure organizations wishing to solicit donations from Federal employees in the workplace are portraying... Section 950.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE...

  18. 5 CFR 950.203 - Public accountability standards.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PRIVATE VOLUNTARY ORGANIZATIONS Eligibility Provisions § 950.203 Public accountability standards. (a) To insure organizations wishing to solicit donations from Federal employees in the workplace are portraying... Section 950.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE...

  19. 7 CFR 1700.32 - Program Accounting and Regulatory Analysis.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 11 2014-01-01 2014-01-01 false Program Accounting and Regulatory Analysis. 1700.32... SERVICE, DEPARTMENT OF AGRICULTURE GENERAL INFORMATION Agency Organization and Functions § 1700.32 Program Accounting and Regulatory Analysis. RUS, through Program Accounting and Regulatory Analysis, monitors and...

  20. 7 CFR 1700.32 - Program Accounting and Regulatory Analysis.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 11 2013-01-01 2013-01-01 false Program Accounting and Regulatory Analysis. 1700.32... SERVICE, DEPARTMENT OF AGRICULTURE GENERAL INFORMATION Agency Organization and Functions § 1700.32 Program Accounting and Regulatory Analysis. RUS, through Program Accounting and Regulatory Analysis, monitors and...

  1. An agent-based simulation model to study accountable care organizations.

    PubMed

    Liu, Pai; Wu, Shinyi

    2016-03-01

    Creating accountable care organizations (ACOs) has been widely discussed as a strategy to control rapidly rising healthcare costs and improve quality of care; however, building an effective ACO is a complex process involving multiple stakeholders (payers, providers, patients) with their own interests. Also, implementation of an ACO is costly in terms of time and money. Immature design could cause safety hazards. Therefore, there is a need for analytical model-based decision-support tools that can predict the outcomes of different strategies to facilitate ACO design and implementation. In this study, an agent-based simulation model was developed to study ACOs that considers payers, healthcare providers, and patients as agents under the shared saving payment model of care for congestive heart failure (CHF), one of the most expensive causes of sometimes preventable hospitalizations. The agent-based simulation model has identified the critical determinants for the payment model design that can motivate provider behavior changes to achieve maximum financial and quality outcomes of an ACO. The results show nonlinear provider behavior change patterns corresponding to changes in payment model designs. The outcomes vary by providers with different quality or financial priorities, and are most sensitive to the cost-effectiveness of CHF interventions that an ACO implements. This study demonstrates an increasingly important method to construct a healthcare system analytics model that can help inform health policy and healthcare management decisions. The study also points out that the likely success of an ACO is interdependent with payment model design, provider characteristics, and cost and effectiveness of healthcare interventions.

  2. The role of health information technology in advancing care management and coordination in accountable care organizations.

    PubMed

    Wu, Frances M; Shortell, Stephen M; Rundall, Thomas G; Bloom, Joan R

    To be successful, accountable care organizations (ACOs) must effectively manage patient care. Health information technology (HIT) can support care delivery by providing various degrees of coordination. Few studies have examined the role of HIT functionalities or the role of different levels of coordination enabled by HIT on care management processes. We examine HIT functionalities in ACOs, categorized by the level of coordination they enable in terms of information and work flow, to determine which specific HIT functionalities and levels of coordination are most strongly associated with care management processes. Retrospective cross-sectional analysis was done using 2012 data from the National Survey of Accountable Care Organizations. HIT functionalities are categorized into coordination levels: information capture, the lowest level, which coordinates through standardization; information provision, which supports unidirectional activities; and information exchange, which reflects the highest level of coordination allowing for bidirectional exchange. The Care Management Process index (CMP index) includes 13 questions about the extent to which care is planned, monitored, and supported by providers and patients. Multiple regressions adjusting for organizational and ACO contractual factors are used to assess relationships between HIT functionalities and the CMP index. HIT functionality coordinating the most complex interdependences (information exchange) was associated with a 0.41 standard deviation change in the CMP index (β = .41, p < .001), but the associations for information capture (β = -.01, p = .97) and information provision (β = .15, p = .48) functionalities were not significant. The current study has shed some light on the relationship between HIT and care management processes by specifying the coordination roles that HIT may play and, in particular, the importance of information exchange functionalities. Although these represent early findings, further

  3. A New Look at Accountability for Your Sales Organization

    ERIC Educational Resources Information Center

    Chabot, Daniel

    1976-01-01

    The problem of increasing costs in acquiring sales can be met by training salespeople to become more effective and productive. An accountability system for salespeople and sales managers is presented based on the return on investment management formula, a combination which considers responsibilities, objectives, and indicators. (EC)

  4. Disrupted Nodal and Hub Organization Account for Brain Network Abnormalities in Parkinson's Disease.

    PubMed

    Koshimori, Yuko; Cho, Sang-Soo; Criaud, Marion; Christopher, Leigh; Jacobs, Mark; Ghadery, Christine; Coakeley, Sarah; Harris, Madeleine; Mizrahi, Romina; Hamani, Clement; Lang, Anthony E; Houle, Sylvain; Strafella, Antonio P

    2016-01-01

    The recent application of graph theory to brain networks promises to shed light on complex diseases such as Parkinson's disease (PD). This study aimed to investigate functional changes in sensorimotor and cognitive networks in Parkinsonian patients, with a focus on inter- and intra-connectivity organization in the disease-associated nodal and hub regions using the graph theoretical analyses. Resting-state functional MRI data of a total of 65 participants, including 23 healthy controls (HCs) and 42 patients, were investigated in 120 nodes for local efficiency, betweenness centrality, and degree. Hub regions were identified in the HC and patient groups. We found nodal and hub changes in patients compared with HCs, including the right pre-supplementary motor area (SMA), left anterior insula, bilateral mid-insula, bilateral dorsolateral prefrontal cortex (DLPFC), and right caudate nucleus. In general, nodal regions within the sensorimotor network (i.e., right pre-SMA and right mid-insula) displayed weakened connectivity, with the former node associated with more severe bradykinesia, and impaired integration with default mode network regions. The left mid-insula also lost its hub properties in patients. Within the executive networks, the left anterior insular cortex lost its hub properties in patients, while a new hub region was identified in the right caudate nucleus, paralleled by an increased level of inter- and intra-connectivity in the bilateral DLPFC possibly representing compensatory mechanisms. These findings highlight the diffuse changes in nodal organization and regional hub disruption accounting for the distributed abnormalities across brain networks and the clinical manifestations of PD.

  5. Costs of accountable care organization participation for primary care providers: early stage results.

    PubMed

    Hofler, Richard A; Ortiz, Judith

    2016-07-28

    Little is known about the impact of joining an Accountable Care Organization (ACO) on primary care provider organization's costs. The purpose of this study was to determine whether joining an ACO is associated with an increase in a Rural Health Clinic's (RHC's) cost per visit. The analyses focused on cost per visit in 2012 and 2013 for RHCs that joined an ACO in 2012 and cost per visit in 2013 for RHCs that joined an ACO in 2013. The RHCs were located in nine states. Data were obtained from Medicare Cost Reports. The analysis was conducted taking a treatment effects approach where the treatment is joining an ACO. Propensity-score matching was employed to provide multiple single and pooled estimates of the average treatment effect on the treated. Four-hundred thirty four to 544 RHCs (depending on the type of analysis and the variables used) were used in the several analyses. Seven of the RHCs joined an ACO in 2012 and 14 joined an ACO in 2013. The mean cost per visit for RHCs that did not join an ACO rose 4.40 % from 2011 to 2012 whereas the mean cost per visit for RHCs that joined an ACO rose by triple: 13.5 %. All of the pooled estimates of the average treatment effect on the treated from the propensity-score matching showed that joining an ACO was associated with higher mean cost per visit. The range of the estimated mean cost per visit differences was $17.19 (p value = 0.00) to $25.19 (p value = 0.00). This study is one of the first to describe the cost of ACO participation from the perspective of primary care provider organizations. It appears that for at least one type of primary care provider - the RHC - there are substantial costs associated with ACO participation during the first two years.

  6. New Summary Measures of Population Health and Well-Being for Implementation by Health Plans and Accountable Care Organizations

    PubMed Central

    Gallagher, Jason M.; Rauri, Sachin; Tillema, Juliana O.; Pronk, Nicolaas P.; Knudson, Susan M.

    2016-01-01

    Health plans and accountable care organizations measure many indicators of patient health, with standard metrics that track factors such as patient experience and cost. They lack, however, a summary measure of the third leg of the Triple Aim, population health. In response, HealthPartners has developed summary measures that align with the recommendations of the For the Public’s Health series of reports from the Institute of Medicine. (The series comprises the following 3 reports: For the Public’s Health: Investing in a Healthier Future, For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges, and For the Public’s Health: The Role of Measurement in Action and Accountability.) The summary measures comprise 3 components: current health, sustainability of health, and well-being. The measure of current health is disability-adjusted life years (DALYs) calculated from health care claims and death records. The sustainability of health measure comprises member reporting of 6 behaviors associated with health plus a clinical preventive services index that indicates adherence to evidence-based preventive care guidelines. Life satisfaction represents the summary measure of subjective well-being. HealthPartners will use the summary measures to identify and address conditions and factors that have the greatest impact on the health and well-being of its patients, members, and community. The method could easily be implemented by other institutions and organizations in the United States, helping to address a persistent need in population health measurement for improvement. PMID:27390075

  7. New Summary Measures of Population Health and Well-Being for Implementation by Health Plans and Accountable Care Organizations.

    PubMed

    Kottke, Thomas E; Gallagher, Jason M; Rauri, Sachin; Tillema, Juliana O; Pronk, Nicolaas P; Knudson, Susan M

    2016-07-07

    Health plans and accountable care organizations measure many indicators of patient health, with standard metrics that track factors such as patient experience and cost. They lack, however, a summary measure of the third leg of the Triple Aim, population health. In response, HealthPartners has developed summary measures that align with the recommendations of the For the Public's Health series of reports from the Institute of Medicine. (The series comprises the following 3 reports: For the Public's Health: Investing in a Healthier Future, For the Public's Health: Revitalizing Law and Policy to Meet New Challenges, and For the Public's Health: The Role of Measurement in Action and Accountability.) The summary measures comprise 3 components: current health, sustainability of health, and well-being. The measure of current health is disability-adjusted life years (DALYs) calculated from health care claims and death records. The sustainability of health measure comprises member reporting of 6 behaviors associated with health plus a clinical preventive services index that indicates adherence to evidence-based preventive care guidelines. Life satisfaction represents the summary measure of subjective well-being. HealthPartners will use the summary measures to identify and address conditions and factors that have the greatest impact on the health and well-being of its patients, members, and community. The method could easily be implemented by other institutions and organizations in the United States, helping to address a persistent need in population health measurement for improvement.

  8. Future considerations for clinical dermatology in the setting of 21st century American policy reform: Accountable Care Organizations.

    PubMed

    Nguyen, Harrison P; Barbieri, John S; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

    2017-01-01

    An Accountable Care Organization (ACO) is a network of providers that collaborates to manage care and is financially incentivized to realize cost savings while also optimizing standards of care. Since its introduction as part of the 2010 Patient Protection and Affordable Care Act, ACOs have grown to include 16% of Medicare beneficiaries and currently represent Medicare's largest payment initiative. Although ACOs are still in the pilot phase with multiple structural models being assessed, incentives are being introduced to encourage specialist participation, and dermatologists will have the opportunity to influence both the cost savings and quality standard aspects of these organizations. In this article, part of a health care policy series targeted to dermatologists, we review what an ACO is, its relevance to dermatologists, and essential factors to consider when joining and negotiating with an ACO. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Accountability through Assessment of Administrative Organizations in Higher Education

    ERIC Educational Resources Information Center

    Kniola, David J.

    2013-01-01

    Accountability is among the least understood policy issues in higher education (Burke 2005). The rapid rise in tuition costs in both public and private institutions (Heller 2006) in all corners of the globe (Altbach, Reisberg, and Rumbley 2009) has challenged the idea of higher education as a public good. Student learning outcomes is one…

  10. Organizational responses to accountability requirements: Do we get what we expect?

    PubMed

    Gray, Carolyn Steele; Berta, Whitney; Deber, Raisa; Lum, Janet

    In health care, accountability is being championed as a promising approach to meeting the dual imperatives of improving care quality while managing constrained budgets. Few studies focus on public sector organizations' responsiveness to government imperatives for accountability. We applied and adapted a theory of organizational responsiveness to community care agencies operating in Ontario, Canada, asking the question: What is the array of realized organizational responses to government-imposed accountability requirements among community agencies that receive public funds to provide home and community care? A sequential complementary mixed methods approach was used. It gathered data through a survey of 114 home and community care organizations in Ontario and interviews with 20 key informants representing 13 home and community care agencies and four government agencies. It generated findings using a parallel mixed analysis technique. In addition to responses predicted by the theory, we found that organizations engage in active, as well as passive, forms of compliance; we refer to this response as internal modification in which internal policies, practices, and/or procedures are changed to meet accountability requirements. We also found that environmental factors, such as the presence of an association representing organizational interests, can influence bargaining tactics. Our study helps us to better understand the range of likely responses to accountability requirements and is a first step toward encouraging the development of accountability frameworks that favor positive outcomes for organizations and those holding them to account. Tailoring agreements to organizational environments, aligning perceived compliance with behaviors that encourage improved performance, and allowing for flexibility in accountability arrangements are suggested strategies to support beneficial outcomes.

  11. An Early Assessment of Accountable Care Organizations Efforts to Engage Patients and Their Families

    PubMed Central

    Shortell, Stephen M.; Sehgal, Neil; Bibi, Salma; Ramsay, Patricia P.; Neuhauser, Linda; Colla, Carrie H.; Lewis, Valerie A.

    2017-01-01

    Accountable Care Organizations (ACOs) have incentives to meet quality and expenditure targets and share in resulting savings. Achieving these goals will require ACOs to engage more actively with patients and their families. The extent to which ACOs do so is currently unknown. Using mixed-methods including a national survey, phone interviews and site-visits; we examine the extent to which ACOs actively engage patients and their families, explore challenges involved; and consider approaches for dealing with those challenges. Results indicate that greater ACO use of patient activation and engagement (PAE) activities at the point-of-care may influence more positive leadership perceptions of the impact of PAE investments on ACO costs, quality, and outcomes of care. We identify a number of important practices associated with greater PAE, including high-level leadership commitment, goal-setting supported by adequate resources, extensive provider training and use of inter-disciplinary care teams, and frequent monitoring and reporting on progress. PMID:26038349

  12. Patient Population Loss At A Large Pioneer Accountable Care Organization And Implications For Refining The Program.

    PubMed

    Hsu, John; Price, Mary; Spirt, Jenna; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Mohta, Namita; Weil, Eric; Ferris, Timothy

    2016-03-01

    There is an ongoing move toward payment models that hold providers increasingly accountable for the care of their patients. The success of these new models depends in part on the stability of patient populations. We investigated the amount of population turnover in a large Medicare Pioneer accountable care organization (ACO) in the period 2012-14. We found that substantial numbers of beneficiaries became part of or left the ACO population during that period. For example, nearly one-third of beneficiaries who entered in 2012 left before 2014. Some of this turnover reflected that of ACO physicians-that is, beneficiaries whose physicians left the ACO were more likely to leave than those whose physicians remained. Some of the turnover also reflected changes in care delivery. For example, beneficiaries who were active in a care management program were less likely to leave the ACO than similar beneficiaries who had not yet started such a program. We recommend policy changes to increase the stability of ACO beneficiary populations, such as permitting lower cost sharing for care received within an ACO and requiring all beneficiaries to identify their primary care physician before being linked to an ACO. Project HOPE—The People-to-People Health Foundation, Inc.

  13. Tracking the Global Distribution of Persistent Organic Pollutants Accounting for E-Waste Exports to Developing Regions.

    PubMed

    Breivik, Knut; Armitage, James M; Wania, Frank; Sweetman, Andrew J; Jones, Kevin C

    2016-01-19

    Elevated concentrations of various industrial-use Persistent Organic Pollutants (POPs), such as polychlorinated biphenyls (PCBs), have been reported in some developing areas in subtropical and tropical regions known to be destinations of e-waste. We used a recent inventory of the global generation and exports of e-waste to develop various global scale emission scenarios for industrial-use organic contaminants (IUOCs). For representative IUOCs (RIUOCs), only hypothetical emissions via passive volatilization from e-waste were considered whereas for PCBs, historical emissions throughout the chemical life-cycle (i.e., manufacturing, use, disposal) were included. The environmental transport and fate of RIUOCs and PCBs were then simulated using the BETR Global 2.0 model. Export of e-waste is expected to increase and sustain global emissions beyond the baseline scenario, which assumes no export. A comparison between model predictions and observations for PCBs in selected recipient regions generally suggests a better agreement when exports are accounted for. This study may be the first to integrate the global transport of IUOCs in waste with their long-range transport in air and water. The results call for integrated chemical management strategies on a global scale.

  14. Social media and flu: Media Twitter accounts as agenda setters.

    PubMed

    Yun, Gi Woong; Morin, David; Park, Sanghee; Joa, Claire Youngnyo; Labbe, Brett; Lim, Jongsoo; Lee, Sooyoung; Hyun, Daewon

    2016-07-01

    This paper has two objectives. First, it categorizes the Twitter handles tweeted flu related information based on the amount of replies and mentions within the Twitter network. The collected Twitter accounts are categorized as media, health related individuals, organizations, government, individuals with no background with media or medical field, in order to test the relationship between centrality measures of the accounts and their categories. The second objective is to examine the relationship between the importance of the Twitter accounts in the network, centrality measures, and specific characteristics of each account, including the number of tweets and followers as well as the number of accounts followed and liked. Using Twitter search network API, tweets with "flu" keyword were collected and tabulated. Network centralities were calculated with network analysis tool, NodeXL. The collected Twitters accounts were content analyzed and categorized by multiple coders. When the media or organizational Twitter accounts were present in the list of important Twitter accounts, they were highly effective disseminating flu-related information. Also, they were more likely to stay active one year after the data collection period compared to other influential individual accounts. Health campaigns are recommended to focus on recruiting influential Twitter accounts and encouraging them to retweet or mention in order to produce better results in disseminating information. Although some individual social media users were valuable assets in terms of spreading information about flu, media and organization handles were more reliable information distributors. Thus, health information practitioners are advised to design health campaigns better utilizing media and organizations rather than individuals to achieve consistent and efficient campaign outcomes. Published by Elsevier Ireland Ltd.

  15. Federal Funding Accountability and Transparency Act

    EPA Pesticide Factsheets

    Public Law 109-282, the Federal Funding Accountability and Transparency Act of 2006 as amended (FFATA), requires disclosure of all entities and organizations receiving Federal funds through a single publicly accessible website.

  16. Implementing SFAS No 121: Accounting for Impaired Assets.

    PubMed

    Luecke, R W; Meeting, D T; Stotzer, W G

    1996-10-01

    In March 1995, FASB issued Statement of Financial Accounting Standards (SFAS) No. 121: "Accounting for the Impairment of Long-Lived Assets and for Long-Lived Assets to be Disposed Of." It establishes accounting standards for assets whose carrying costs have been overstated due to a variety of circumstances that have reduced the value of the assets. Healthcare financial managers should fully understand the statement's implications for their organizations.

  17. Accounting guidelines for HMOs: issues and practices.

    PubMed

    Ingram, R W; Robbins, W A

    1987-03-01

    HMOs are fast becoming an important part of the healthcare industry today. Unfortunately, specific accounting guidelines have not yet been established for them. This concern has led the AICPA to describe and offer recommendations concerning preferred accounting techniques for HMOs. This article looks at the issues raised by the AICPA and how current HMO financial officers feel about the practices that are recommended. It is suggested that the organization, taxability, and other attributes of an HMO must be clearly understood before strict accounting guidelines are imposed.

  18. 29 CFR 458.32 - Provision for accounting and financial controls.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Provision for accounting and financial controls. 458.32... Additional Provisions Applicable § 458.32 Provision for accounting and financial controls. Every labor organization shall provide accounting and financial controls necessary to assure the maintenance of fiscal...

  19. 75 FR 17297 - Account Class

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-06

    ...'') (CL01). \\10\\ The Futures Industry Association (representing the commodity futures and options industry... clearing through a Futures Commission Merchant * * * to a Derivatives Clearing Organization.'' 73 FR 65514... cleared OTC derivative (and relevant collateral) to be included in the futures account class rather than...

  20. Accounting for Organic Carbon Change in Deep Soil Altered Carbon Sequestration Efficiency

    NASA Astrophysics Data System (ADS)

    Li, J.; Liang, F.; Xu, M.; Huang, S.

    2017-12-01

    Study on soil organic carbon (SOC) sequestration under fertilization practices in croplands lacks information of soil C change at depth lower than plow layer (i.e. 20 30-cm). By synthesizing long-term datasets of fertilization experiments in four typical Chinese croplands representing black soil at Gongzhuling(GZL), aquatic Chao soil at Zhengzhou(ZZ), red soil at Qiyang(QY) and purple soil at Chongqing(CQ) city, we calculated changes in SOC storage relative to initial condition (ΔSOC) in 0-20cm and 0-60cm, organic C inputs (OC) from the stubble, roots and manure amendment, and C sequestration efficiency (CSE: the ratio of ΔSOC over OC) in 0-20cm and 0-60cm. The fertilization treatments include cropping with no fertilization (CK), chemical nitrogen, phosphorus and potassium fertilizers (NPK) and combined chemical fertilizers and manure (NPKM). Results showed SOC storage generally decreased with soil depth (i.e. 0-20 > 20-40, 40-60 cm) and increased with fertilizations (i.e. initial < CK < NPK < NPKM). The annual OC input to soil remained relatively stable and manure input was the primary source of OC input under NPKM treatment. Assuming all OC input remained at 0-60cm and 50 90% distributed at 0-20cm, our results supported that CSE at 0-60cm was consistently larger than that at 0-20cm under NPK and NPKM at GZL (p-value<0.05), but significantly lower under NPK at ZZ and QY (p-value<0.05). These results demonstrated that under long-term fertilizations, soil at depth (>20cm) can act as important soil carbon sinks in intrinsically high fertility soils (i.e. black soil) but less likely at poor fertility soil (i.e. aquatic Chao soil). It thus informs the need to account for C change in deep soils for estimating soil C sequestration capacity particularly with indigenously fertile cropland soils.

  1. An academic health center sees both challenges and enabling forces as it creates an accountable care organization.

    PubMed

    Tallia, Alfred F; Howard, Jenna

    2012-11-01

    Health care reform presents academic health centers with an opportunity to test new systems of care, such as accountable care organizations (ACOs), that are intended to improve patients' health and well-being, mitigate the anticipated shortage in primary care providers, and bend the cost curve. In its ongoing efforts to develop an ACO, the Robert Wood Johnson Medical School, an academic health center, has found helpful a rapidly evolving competitive environment and insurers willing to experiment with new models of care. But the center has also encountered six types of barriers: conceptual, financial, cultural, regulatory, organizational, and historical. How this academic health center has faced these barriers offers valuable lessons to other health systems engaged in creating ACOs.

  2. Documentation and Analysis of the ’Miscellaneous’ Account Category within the DoD Instruction 7220.29-H Depot Level Maintenance Cost Accounting System.

    DTIC Science & Technology

    1984-12-01

    34MISCELLANEOUS" ACCOUNT CATEGORY WITHIN THE DOD INSTRUCTION 7220.29-H DEPOT LEVEL MAINTENANCE COST ACCOUNTING SYSTEM by a. Steven Eugene Lehr CDecember 1984...PERFORMING ONG. REPORT NUMBER Maintenance Cost Accounting System 7. AUTHOR(&) S. CONTRACT OR GRANT NUMBER(@) Steven Eugene Lehr 9. PERFORMING ORGANIZATION...Availability Codes IS. KEY WORDS (Continue on reverse *ids It necessary and Identify by block number) Dvi Special Uniform Cost Accounting System DoD

  3. Disrupted Nodal and Hub Organization Account for Brain Network Abnormalities in Parkinson’s Disease

    PubMed Central

    Koshimori, Yuko; Cho, Sang-Soo; Criaud, Marion; Christopher, Leigh; Jacobs, Mark; Ghadery, Christine; Coakeley, Sarah; Harris, Madeleine; Mizrahi, Romina; Hamani, Clement; Lang, Anthony E.; Houle, Sylvain; Strafella, Antonio P.

    2016-01-01

    The recent application of graph theory to brain networks promises to shed light on complex diseases such as Parkinson’s disease (PD). This study aimed to investigate functional changes in sensorimotor and cognitive networks in Parkinsonian patients, with a focus on inter- and intra-connectivity organization in the disease-associated nodal and hub regions using the graph theoretical analyses. Resting-state functional MRI data of a total of 65 participants, including 23 healthy controls (HCs) and 42 patients, were investigated in 120 nodes for local efficiency, betweenness centrality, and degree. Hub regions were identified in the HC and patient groups. We found nodal and hub changes in patients compared with HCs, including the right pre-supplementary motor area (SMA), left anterior insula, bilateral mid-insula, bilateral dorsolateral prefrontal cortex (DLPFC), and right caudate nucleus. In general, nodal regions within the sensorimotor network (i.e., right pre-SMA and right mid-insula) displayed weakened connectivity, with the former node associated with more severe bradykinesia, and impaired integration with default mode network regions. The left mid-insula also lost its hub properties in patients. Within the executive networks, the left anterior insular cortex lost its hub properties in patients, while a new hub region was identified in the right caudate nucleus, paralleled by an increased level of inter- and intra-connectivity in the bilateral DLPFC possibly representing compensatory mechanisms. These findings highlight the diffuse changes in nodal organization and regional hub disruption accounting for the distributed abnormalities across brain networks and the clinical manifestations of PD. PMID:27891090

  4. The Economics of Provider Payment Reform: Are Accountable Care Organizations the Answer?

    PubMed

    Feldman, Roger

    2015-08-01

    A remarkable consensus has developed that the fee-for-service (FFS) approach for paying medical providers must be replaced. This payment approach is said to increase the volume of services without improving care coordination. In response to these calls, Medicare and private payers are experimenting with payment systems that combine the basic element of FFS - a fee for each service - with arrangements that allow providers to share the savings if they hold total spending per patient below a targeted amount. Medicare's accountable care organizations (ACOs) embody the shared savings approach to payment reform. Private payers have introduced total cost of care contracting (TCOC) in several locations. This article questions the consensus that FFS must go. If the fees are too high, then someone needs to "bite the bullet" and reduce fees in key areas. Hoping to control overspending by investment in ACOs is wishful thinking. I describe the theory and practice of shared savings payment systems and summarize recent TCOC contracting initiatives in the private sector. Medicare's shared savings approach is likely to be less effective than private contracts. Cutting providers' fees would be more efficient. Finally, the new payment models in the Affordable Care Act will not ease the problem of high prices for private payers. Copyright © 2015 by Duke University Press.

  5. FASB issues new accounting standards for business combinations.

    PubMed

    Heuer, Christian; Travers, Mary Ann K

    2010-06-01

    Accounting Standard Codification Topic 958 (formerly Financial Accounting Standards Board Statement No. 164), Not-for-Profit Entities: Mergers and Acquisitions, applies to mergers and acquisitions as early as Jan. 1, 2010, for calendar-year entities. Not-for-profit organizations need to move to fair value accounting, with a focus on the valuation of intangible assets. Noncompliance could cause a hospital's auditors to issue a qualified report, which could lead to difficulties obtaining bank and bond financing.

  6. Clinical coordination in accountable care organizations: A qualitative study.

    PubMed

    Lewis, Valerie A; Schoenherr, Karen; Fraze, Taressa; Cunningham, Aleen

    2016-12-06

    Accountable care organizations (ACOs) are becoming a common payment and delivery model. Despite widespread interest, little empirical research has examined what efforts or strategies ACOs are using to change care and reduce costs. Knowledge of ACOs' clinical efforts can provide important context for understanding ACO performance, particularly to distinguish arenas where ACOs have and have not attempted care transformation. The aim of the study was to understand ACOs' efforts to change clinical care during the first 18 months of ACO contracts. We conducted semistructured interviews between July and December 2013. Our sample includes ACOs that began performance contracts in 2012, including Medicare Shared Savings Program and Pioneer participants, stratified across key factors. In total, we conducted interviews with executives from 30 ACOs. Iterative qualitative analysis identified common patterns and themes. ACOs in the first year of performance contracts are commonly focusing on four areas: first, transforming primary care through increased access and team-based care; second, reducing avoidable emergency department use; third, strengthening practice-based care management; and fourth, developing new boundary spanner roles and activities. ACOs were doing little around transforming specialty care, acute and postacute care, or standardizing care across practices during the first 18 months of ACO performance contracts. Results suggest that cost reductions associated with ACOs in the first years of contracts may be related to primary care. Although in the long term many hope ACOs will achieve coordination across a wide array of care settings and providers, in the short term providers under ACO contracts are focused largely on primary care-related strategies. Our work provides a template of the common areas of clinical activity in the first years of ACO contracts, which may be informative to providers considering becoming an ACO. Further research will be needed to

  7. The ultimately accountable job: leading today's sales organization.

    PubMed

    Colletti, Jerome A; Fiss, Mary S

    2006-01-01

    In recent years, sales leaders have had to devote considerable time and energy to establishing and maintaining disciplined processes. The thing is, many of them stop there--and they can't afford to, because the business environment has changed. Customers have gained power and gone global, channels have proliferated, more product companies are selling services, and many suppliers have begun providing a single point of contact for customers. Such changes require today's sales leaders to fill various new roles: Company leader. The best sales chiefs actively help formulate and execute company strategy, and they collaborate with all functions of the business to deliver value to customers. Customer champion. Customers want C-level relationships with suppliers in order to understand product strategy, look at offerings in advance, and participate in decisions made about future products--and sales leaders are in the best position to offer that kind of contact. Process guru. Although sales chiefs must look beyond the sales and customer processes they have honed over the past decade, they can't abandon them. The focus on process has become only more important as many organizations have begun bundling products and services to meet important customers' individual needs. Organization architect. Good sales leaders spend a lot of time evaluating and occasionally redesigning the sales organization's structure to ensure that it supports corporate strategy. Often, this involves finding the right balance between specialized and generalized sales roles. Course corrector. Sales leaders must watch the horizon, but they can't take their hands off the levers or forget about the dials. If they do, they might fail to respond when quick adjustments in priorities are needed.

  8. Accountability for end-stage organ care: implications of geographic variation in access to kidney transplantation.

    PubMed

    Axelrod, David A; Lentine, Krista L; Xiao, Huiling; Bubolz, Thomas; Goodman, David; Freeman, Richard; Tuttle-Newhall, Janet E; Schnitzler, Mark A

    2014-05-01

    The provision of effective surgical care for end-stage renal disease (ESRD) requires efficient evaluation and transplantation. Prior assessments of transplant access have focused primarily on waitlisted patients rather than the overall populations served by "accountable" providers of transplant services. Novel transplant referral regions (TRRs) were defined using United Network for Organ Sharing registry data for 301,092 kidney transplant listings to assign zip codes to "accountable" transplant programs. Subsequently, risk-adjusted observed to expected (O:E) rates of listing and transplant procedures were calculated for each TRR. Finally, the impact of variation in TRR listing and transplant rates on mortality was assessed for ESRD patients <60 years old diagnosed between 2000 and 2008. In total, 113 TRRs were defined, 51% of which included >1 transplant center. The likelihood of being evaluated and listed for transplant varied significantly between TRRs (risk-adjusted O:E, 0.58-1.95). Variation was greater for the overall transplant rate (0.62-2.19), living donor transplantation (0.36-3.08), and donation after cardiac death transplant (0-15.4) than for standard criteria donors (0.64-2.86). Mortality was decreased for ESRD patients living in TRRs in the highest tertile of listings (hazard ratio, 0.89; P < .0001) and transplantation (0.90; P < .0001). Residence in a TRR with care delivery systems that increase access to transplant services is associated with significant, risk-adjusted decreases in ESRD-related mortality. Transplant centers should continue to focus on improving access to care within the communities they serve. Copyright © 2014 Mosby, Inc. All rights reserved.

  9. Changes in Low-Value Services in Year 1 of the Medicare Pioneer Accountable Care Organization Program.

    PubMed

    Schwartz, Aaron L; Chernew, Michael E; Landon, Bruce E; McWilliams, J Michael

    2015-11-01

    Wasteful practices are widespread in the US health care system. It is unclear if payment models intended to improve health care efficiency, such as the Medicare accountable care organization (ACO) programs, discourage the provision of low-value services. To assess whether the first year of the Medicare Pioneer ACO program was associated with a reduction in use of low-value services. In a difference-in-differences analysis, we compared use of low-value services between Medicare fee-for-service beneficiaries attributed to health care provider groups that entered the Pioneer program (ACO group) and beneficiaries attributed to other health care providers (control group) before (2009-2011) vs after (2012) Pioneer ACO contracts began. Data analysis was conducted from December 1, 2014, to June 27, 2015. Comparisons were adjusted for beneficiaries' sociodemographic and clinical characteristics as well as for geography. We decomposed estimates according to service characteristics (clinical category, price, and sensitivity to patient preferences) and compared estimates between subgroups of ACOs with higher vs lower baseline use of low-value services. Use of, and spending on, 31 services in instances that provide minimal clinical benefit, measured as annual service counts per 100 beneficiaries and price-standardized annual service spending per 100 beneficiaries. During the precontract period, trends in the use of low-value services were similar for the ACO and control groups. The first year of ACO contracts was associated with a differential reduction (95% CI) of 0.8 low-value services per 100 beneficiaries for the ACO group (-1.2 to -0.4; P < .001), corresponding to a 1.9% differential reduction in service quantity (-2.9% to -0.9%) and a 4.5% differential reduction in spending on low-value services (-7.5% to -1.4%; P = .004). Differential reductions were similar for services less sensitive vs more sensitive to patient preferences and for higher- vs lower-priced services

  10. A New Approach to Accountability: Creating Effective Learning Environments for Programs

    ERIC Educational Resources Information Center

    Surr, Wendy

    2012-01-01

    This article describes a new paradigm for accountability that envisions afterschool programs as learning organizations continually engaged in improving quality. Nearly 20 years into the era of results-based accountability, a new generation of afterschool accountability systems is emerging. Rather than aiming to test whether programs have produced…

  11. 32 CFR 1701.9 - Requests for an accounting of record disclosures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Requests for an accounting of record disclosures... of record disclosures. (a) How to request. Except where accountings of disclosures are not required... representatives) may request an accounting of disclosures that have been made to another person, organization, or...

  12. Managerial Accounting. Course Administrative Manual.

    ERIC Educational Resources Information Center

    Central Michigan Univ., Mount Pleasant. Inst. for Personal and Career Development.

    This manual is part of the materials for a college-level programmed course in managerial accounting and intended to aid instructors in helping students to work their way through the self-instructional study guide around which the course is organized. The manual describes the various materials and components used in the self-instructional sequence…

  13. Delivery system characteristics and their association with quality and costs of care: implications for accountable care organizations.

    PubMed

    Chukmaitov, Askar; Harless, David W; Bazzoli, Gloria J; Carretta, Henry J; Siangphoe, Umaporn

    2015-01-01

    Implementation of accountable care organizations (ACOs) is currently underway, but there is limited empirical evidence on the merits of the ACO model. The aim was to study the associations between delivery system characteristics and ACO competencies, including centralization strategies to manage organizations, hospital integration with physicians and outpatient facilities, health information technology, infrastructure to monitor community health and report quality, and risk-adjusted 30-day all-cause mortality and case-mixed-adjusted inpatient costs for the Medicare population. Panel data (2006-2009) were assembled from Florida and multiple sources: inpatient hospital discharge, vital statistics, the American Hospital Association, the Healthcare Information and Management Systems Society, and other databases. We applied a panel study design, controlling for hospital and market characteristics. Hospitals that were in centralized health systems or became more centralized over the study period had significantly larger reductions in mortality compared with hospitals that remained freestanding. Surprisingly, tightly integrated hospital-physician arrangements were associated with increased mortality; as such, hospitals may wish to proceed cautiously when developing specific types of alignment with local physician organizations. We observed no statistically significant differences in the growth rate of costs across hospitals in any of the health systems studied relative to freestanding hospitals. Although we observed quality improvement in some organizational types, these outcome improvements were not coupled with the additional desired objective of lower cost growth. This implies that additional changes not present during our study period, potentially changes in provider payment approaches, are essential for achieving the ACO objectives of higher quality of care at lower costs. Provider organizations implementing ACOs should consider centralizing service delivery as a

  14. Contributions of relational coordination to care management in accountable care organizations: Views of managerial and clinical leaders.

    PubMed

    Rundall, Thomas G; Wu, Frances M; Lewis, Valerie A; Schoenherr, Karen E; Shortell, Stephen M

    2016-01-01

    The accountable care organization (ACO) is a new type of health care organization incentivized to improve quality of care, improve population health, and reduce the cost of care. An ACO's success in meeting these objectives depends greatly upon its ability to improve patient care management. Numerous studies have found relational coordination to be positively associated with key measures of organizational performance in health care organizations, including quality and efficiency. The purpose of this paper is twofold: (a) identify the extent to which ACO leaders are aware of the dimensions of relational coordination, and (b) identify the ways these leaders believe the dimensions influenced care management practices in their organization. We performed content analysis of interviews with managerial and clinical leaders from a diverse group of 11 ACOs to assess awareness of relational coordination and identify the ways that dimensions of relational coordination were perceived to influence development of care management practices. ACO leaders mentioned four relational coordination dimensions: shared goals, frequency of communication, timeliness of communication, and problem solving communication. Three dimensions - shared knowledge of team members' tasks, mutual respect, and accuracy of communication - were not mentioned. Our analysis identified numerous ways leaders believed the four mentioned dimensions contributed to the development of care management, including contributions to standardization of care, patient engagement, coordination of care, and care planning. We propose two hypotheses for future research on relational coordination and care management. If relational coordination is to have a beneficial influence on ACO performance, organizational leaders must become more aware of relational coordination and its various dimensions and become cognizant of relational coordination's influence on care management in their ACO. We suggest a number of means by which ACO

  15. MO-E-17A-06: Organ Dose in Abdomen-Pelvis CT: Does TG 111 Equilibrium Dose Concept Better Accounts for KVp Dependence Than Conventional CTDI?

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Li, X; Morgan, A; Davros, W

    Purpose: In CT imaging, a desirable quality assurance (QA) dose quantity should account for the dose variability across scan parameters and scanner models. Recently, AAPM TG 111 proposed to use equilibrium dose-pitch product, in place of CT dose index (CTDI100), for scan modes involving table translation. The purpose of this work is to investigate whether this new concept better accounts for the kVp dependence of organ dose than the conventional CTDI concept. Methods: The adult reference female extended cardiac-torso (XCAT) phantom was used for this study. A Monte Carlo program developed and validated for a 128-slice CT system (Definition Flash,more » Siemens Healthcare) was used to simulate organ dose for abdomenpelvis scans at five tube voltages (70, 80, 100, 120, 140 kVp) with a pitch of 0.8 and a detector configuration of 2x64x0.6 mm. The same Monte Carlo program was used to simulate CTDI100 and equilibrium dose-pitch product. For both metrics, the central and peripheral values were used together with helical pitch to calculate a volume-weighted average, i.e., CTDIvol and (Deq)vol, respectively. Results: While other scan parameters were kept constant, organ dose depended strongly on kVp; the coefficient of variation (COV) across the five kVp values ranged between 70–75% for liver, spleen, stomach, pancreas, kidneys, colon, small intestine, bladder, and ovaries, all of which were inside the primary radiation beam. One-way analysis of variance (ANOVA) for the effect of kVp was highly significant (p=3e−30). When organ dose was normalized by CTDIvol, the COV across the five kVp values reduced to 7–16%. The effect of kVp was still highly significant (p=4e−4). When organ dose was normalized by (Deq)vol, the COV further reduced to 4−12%. The effect of kVp was borderline significant (p=0.04). Conclusion: In abdomen-pelvis CT, TG 111 equilibrium dose concept better accounts for kVp dependence than the conventional CTDI. This work is supported by a faculty

  16. Educational Accountability and Policy Feedback

    ERIC Educational Resources Information Center

    McDonnell, Lorraine M.

    2013-01-01

    Over the past 30 years, accountability policies have become more prominent in public K-12 education and have changed how teaching and learning are organized. It is less clear the extent to which these policies have altered the politics of education. This article begins to address that question through the lens of policy feedback. It identifies…

  17. Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries.

    PubMed

    Colla, Carrie H; Lewis, Valerie A; Kao, Lee-Sien; O'Malley, A James; Chang, Chiang-Hua; Fisher, Elliott S

    2016-08-01

    Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. Total spending decreased by $34 (95% CI, -$52 to -$15) per

  18. Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

    PubMed Central

    Colla, Carrie H.; Lewis, Valerie A.; Kao, Lee-Sien; O’Malley, A. James; Chang, Chiang-Hua; Fisher, Elliott S.

    2016-01-01

    IMPORTANCE Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. OBJECTIVE To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. DESIGN, SETTING, AND PARTICIPANTS For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. EXPOSURES Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. MAIN OUTCOMES AND MEASURES Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive

  19. Hospital cost accounting and the new imperative.

    PubMed

    Sabin, P

    1987-05-01

    Government regulatory structures, prospective payment mechanisms, a more competitive environment, and attempts to link cost accounting principles to planning, budgeting, and fiscal control all have served as catalysts for hospitals to increase their reliance and emphasis on cost accounting. Current hospital accounting systems are relatively inexpensive to develop and maintain, and they fulfill the financial reporting requirements mandated by Medicare and other third-party payers. These systems, however, do not provide information on what specific service units cost, and managers must have this information to make optimal trade-offs between quality, availability, and cost of medical services. Most health care organizations have a predetermined charge for each type of service, but the charge may not accurately portray the cost of providing the service. Knowing true costs will enable managers to select the most cost-effective method of treating a patient; know the financial implications of adding tests or procedures; relate costs to established norms of care; establish ranges of acceptable costs in various diagnostic groups; negotiate more successfully with rate review organizations and health maintenance organizations; and vigorously market and advertise the services that most contribute to the organization's overall financial health. The goal of microcosting is to determine the full cost of providing specific service units. The microcosting process comprises three components: data collection, cost modeling, and cost analysis. Microcosting is used to determine full costs for 20 percent of the hospital's procedures that are responsible for generating 80 percent of the hospital's gross revenue. Full costs are established by adding labor costs, materials costs, equipment depreciation costs, departmental overhead costs, and corporate overhead costs.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Applying Japanese management tips to patient accounts.

    PubMed

    Groenevelt, C J

    1990-04-01

    "Just in time," a Japanese management philosophy that has been applied successfully in manufacturing operations, also can be used to improve management of patient accounts departments. Under its principles, healthcare organizations would develop standardized procedures; involve workers in decision making; set up training and education programs aimed at creating a multi-skilled pool of workers; establish smooth production schedules; and foster cooperation and commitment to the philosophy throughout the organization.

  1. The feasibility of a scanner-independent technique to estimate organ dose from MDCT scans: Using CTDI{sub vol} to account for differences between scanners

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Turner, Adam C.; Zankl, Maria; DeMarco, John J.

    2010-04-15

    Purpose: Monte Carlo radiation transport techniques have made it possible to accurately estimate the radiation dose to radiosensitive organs in patient models from scans performed with modern multidetector row computed tomography (MDCT) scanners. However, there is considerable variation in organ doses across scanners, even when similar acquisition conditions are used. The purpose of this study was to investigate the feasibility of a technique to estimate organ doses that would be scanner independent. This was accomplished by assessing the ability of CTDI{sub vol} measurements to account for differences in MDCT scanners that lead to organ dose differences. Methods: Monte Carlo simulationsmore » of 64-slice MDCT scanners from each of the four major manufacturers were performed. An adult female patient model from the GSF family of voxelized phantoms was used in which all ICRP Publication 103 radiosensitive organs were identified. A 120 kVp, full-body helical scan with a pitch of 1 was simulated for each scanner using similar scan protocols across scanners. From each simulated scan, the radiation dose to each organ was obtained on a per mA s basis (mGy/mA s). In addition, CTDI{sub vol} values were obtained from each scanner for the selected scan parameters. Then, to demonstrate the feasibility of generating organ dose estimates from scanner-independent coefficients, the simulated organ dose values resulting from each scanner were normalized by the CTDI{sub vol} value for those acquisition conditions. Results: CTDI{sub vol} values across scanners showed considerable variation as the coefficient of variation (CoV) across scanners was 34.1%. The simulated patient scans also demonstrated considerable differences in organ dose values, which varied by up to a factor of approximately 2 between some of the scanners. The CoV across scanners for the simulated organ doses ranged from 26.7% (for the adrenals) to 37.7% (for the thyroid), with a mean CoV of 31.5% across all organs

  2. The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities.

    PubMed

    Bartels, Stephen J; Gill, Lydia; Naslund, John A

    2015-01-01

    The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA.

  3. The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities

    PubMed Central

    Bartels, Stephen J.; Gill, Lydia; Naslund, John A.

    2015-01-01

    Abstract The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA. PMID:25811340

  4. Hong Kong - The Hong Kong Alliance of Patients' Organizations: Working constructively to increase hospital openness and accountability.

    PubMed

    2014-01-01

    The Hong Kong Alliance of Patients' Organizations (HI(APO) comprises 44 affiliated patient groups who advocate across the region, improving patient experiences and increasing advocacy and awareness. Initially established to increase accountability to patients and representation in a changing health system, the Alliance has worked to expand patient input on local and territorial decision-making by partnering with individual hospitals and increasing links with the Hospital Authority Board. Patients are now represented on most committees affecting patient care and the delivery of health services, and more widely in health care policy decision-making. The Alliance advocates for patients as active and constructive consumers rather than passive recipients of services and lobbies for better representation and involvement in treatment decisions. It has also increased media exposure which has helped to grow representation so that patients are now present on all 11 Authority Committees and are asked for their views. The patient ambassadors programme offers training for patients to be representatives at ward level and within the local hospital committee; and by building constructive relationships over time with hospital partners, HKAPO affiliate organizations have been able to start making improvements in the training of professionals in hospitals and informing staff about patient engagement, advocating for new clinical interventions and a more patient-centred approach.

  5. Determination of organic carbon and ionic accountability of various waste and product waters derived from ECLSS water recovery tests and Spacelab humidity condensate

    NASA Technical Reports Server (NTRS)

    Carter, Donald L.; Cole, Harold; Habercom, Mark; Griffith, Guy

    1992-01-01

    The development of a closed-loop water recovery system for Space Station Freedom involves many technical challenges associated with contaminant removal. Attention is presently given to the characterization of contaminants constituting total organic carbon (TOC), and to the Hubaux and Vos (1970) statistical model for low level TOC that has been employed. A tabulation is given for TOC accountability in the case of both potable and hygiene waters.

  6. Property Accountability Task Force

    DTIC Science & Technology

    1978-06-30

    accountability. Many organizations have initiated innovative changes. I can as’,ure you that the pro, edures being put into effect will not be "auick...08184Z MAR 78 B. TRADOC MSG, DTG 031705Z APR 78, SAB 1. REF A REQUESTED THAT YOU PROVIDE DIRECTION TO ALL SERVICE SCHOOLS ON THE USE OF THE LOGISTICS...ABOVE. 3. REQUEST YOU INFORM DAPATF OF YOUR PLANS CONCERNING THE FOLLLOWING POINTS: A. ENSURING THAT ALL STUDENTS MASTER THE SUPPLY PROCEDURES

  7. Pendulum Shifts, Context, Error, and Personal Accountability

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Harold Blackman; Oren Hester

    This paper describes a series of tools that were developed to achieve a balance in under-standing LOWs and the human component of events (including accountability) as the INL continues its shift to a learning culture where people report, are accountable and interested in making a positive difference - and want to report because information is handled correctly and the result benefits both the reporting individual and the organization. We present our model for understanding these interrelationships; the initiatives that were undertaken to improve overall performance.

  8. Baseline map of organic carbon in Australian soil to support national carbon accounting and monitoring under climate change

    PubMed Central

    Viscarra Rossel, Raphael A; Webster, Richard; Bui, Elisabeth N; Baldock, Jeff A

    2014-01-01

    We can effectively monitor soil condition—and develop sound policies to offset the emissions of greenhouse gases—only with accurate data from which to define baselines. Currently, estimates of soil organic C for countries or continents are either unavailable or largely uncertain because they are derived from sparse data, with large gaps over many areas of the Earth. Here, we derive spatially explicit estimates, and their uncertainty, of the distribution and stock of organic C in the soil of Australia. We assembled and harmonized data from several sources to produce the most comprehensive set of data on the current stock of organic C in soil of the continent. Using them, we have produced a fine spatial resolution baseline map of organic C at the continental scale. We describe how we made it by combining the bootstrap, a decision tree with piecewise regression on environmental variables and geostatistical modelling of residuals. Values of stock were predicted at the nodes of a 3-arc-sec (approximately 90 m) grid and mapped together with their uncertainties. We then calculated baselines of soil organic C storage over the whole of Australia, its states and territories, and regions that define bioclimatic zones, vegetation classes and land use. The average amount of organic C in Australian topsoil is estimated to be 29.7 t ha−1 with 95% confidence limits of 22.6 and 37.9 t ha−1. The total stock of organic C in the 0–30 cm layer of soil for the continent is 24.97 Gt with 95% confidence limits of 19.04 and 31.83 Gt. This represents approximately 3.5% of the total stock in the upper 30 cm of soil worldwide. Australia occupies 5.2% of the global land area, so the total organic C stock of Australian soil makes an important contribution to the global carbon cycle, and it provides a significant potential for sequestration. As the most reliable approximation of the stock of organic C in Australian soil in 2010, our estimates have important applications. They

  9. Baseline map of organic carbon in Australian soil to support national carbon accounting and monitoring under climate change.

    PubMed

    Viscarra Rossel, Raphael A; Webster, Richard; Bui, Elisabeth N; Baldock, Jeff A

    2014-09-01

    We can effectively monitor soil condition-and develop sound policies to offset the emissions of greenhouse gases-only with accurate data from which to define baselines. Currently, estimates of soil organic C for countries or continents are either unavailable or largely uncertain because they are derived from sparse data, with large gaps over many areas of the Earth. Here, we derive spatially explicit estimates, and their uncertainty, of the distribution and stock of organic C in the soil of Australia. We assembled and harmonized data from several sources to produce the most comprehensive set of data on the current stock of organic C in soil of the continent. Using them, we have produced a fine spatial resolution baseline map of organic C at the continental scale. We describe how we made it by combining the bootstrap, a decision tree with piecewise regression on environmental variables and geostatistical modelling of residuals. Values of stock were predicted at the nodes of a 3-arc-sec (approximately 90 m) grid and mapped together with their uncertainties. We then calculated baselines of soil organic C storage over the whole of Australia, its states and territories, and regions that define bioclimatic zones, vegetation classes and land use. The average amount of organic C in Australian topsoil is estimated to be 29.7 t ha(-1) with 95% confidence limits of 22.6 and 37.9 t ha(-1) . The total stock of organic C in the 0-30 cm layer of soil for the continent is 24.97 Gt with 95% confidence limits of 19.04 and 31.83 Gt. This represents approximately 3.5% of the total stock in the upper 30 cm of soil worldwide. Australia occupies 5.2% of the global land area, so the total organic C stock of Australian soil makes an important contribution to the global carbon cycle, and it provides a significant potential for sequestration. As the most reliable approximation of the stock of organic C in Australian soil in 2010, our estimates have important applications. They could support

  10. Achieving Service-Learning Goals in a Financial Accounting Class Project

    ERIC Educational Resources Information Center

    Yu, Darwin D.

    2011-01-01

    Background: A financial accounting class in a Philippine university has a service-learning group project that involves setting up a simple accounting system for microenterprises. Aims: This paper examines the extent to which service-learning goals such as course learning, teamwork, civic responsibility, and impact on the client organization are…

  11. History of deceased organ donation, transplantation, and organ procurement organizations.

    PubMed

    Howard, Richard J; Cornell, Danielle L; Cochran, Larry

    2012-03-01

    The historical development of deceased organ donation, transplantation, and organ procurement organizations is reviewed. The concept of transplantation, taking parts from one animal or person and putting them into another animal or person, is ancient. The development of organ transplantation brought on the need for a source of organs. Although many early kidney transplants used kidneys from living donors, these donors could not satisfy the ever-growing need for organs, and extrarenal organs were recovered only from deceased donors. This need for organs to satisfy the great demand led to specialized organizations to identify deceased donors, manage them until recovery occurred, and to notify transplant centers that organs were available for their patients. The functions of these organ procurement organizations expanded to include other required functions such as education, accounting, and compliance with state and federal requirements. Because of the shortage of organs relative to the demand, lack of a unified organ allocation system, the perception that organs are a national resource and should be governed by national regulations, and to improve results of organ procurement organizations and transplant centers, the federal government has regulated virtually all phases of organ procurement and transplantation.

  12. 17 CFR 200.30-11 - Delegation of authority to the Chief Accountant.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Chief Accountant. 200.30-11 Section 200.30-11 Commodity and Securities Exchanges SECURITIES AND EXCHANGE... General Organization § 200.30-11 Delegation of authority to the Chief Accountant. Pursuant to the... Accountant of the Commission, to be performed by him or her or under his or her direction by such person or...

  13. 17 CFR 200.30-11 - Delegation of authority to the Chief Accountant.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Chief Accountant. 200.30-11 Section 200.30-11 Commodity and Securities Exchanges SECURITIES AND EXCHANGE... General Organization § 200.30-11 Delegation of authority to the Chief Accountant. Pursuant to the... Accountant of the Commission, to be performed by him or her or under his or her direction by such person or...

  14. 17 CFR 200.30-11 - Delegation of authority to the Chief Accountant.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Chief Accountant. 200.30-11 Section 200.30-11 Commodity and Securities Exchanges SECURITIES AND EXCHANGE... General Organization § 200.30-11 Delegation of authority to the Chief Accountant. Pursuant to the... Accountant of the Commission, to be performed by him or her or under his or her direction by such person or...

  15. 17 CFR 200.30-11 - Delegation of authority to the Chief Accountant.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Chief Accountant. 200.30-11 Section 200.30-11 Commodity and Securities Exchanges SECURITIES AND EXCHANGE... General Organization § 200.30-11 Delegation of authority to the Chief Accountant. Pursuant to the... Accountant of the Commission, to be performed by him or her or under his or her direction by such person or...

  16. Accounting 10-20-30. Senior High School Teacher Resource Manual.

    ERIC Educational Resources Information Center

    Alberta Dept. of Education, Edmonton. Curriculum Branch.

    This manual is intended to help teachers meet the objectives of the 1985 Alberta, Canada, Accounting 10-20-30 curriculum. The manual is organized in nine sections. The first section introduces the curriculum and lists the course objectives, and the following section provides a flowchart of the accounting modules. Information on planning the…

  17. Should Accountancy Schools and Departments Adopt Theory Z for Their Faculties?

    ERIC Educational Resources Information Center

    Rayburn, L. Gayle

    1990-01-01

    A study to determine if there are features within Japanese organizations that could be adapted to improve organization and working relations of schools of accountancy found university departments could not function with the job rotation found in Japanese organizations. However, there are other aspects of Theory Z management that could be adopted…

  18. 5 CFR 2606.207 - Accounting of disclosures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Section 2606.207 Administrative Personnel OFFICE OF GOVERNMENT ETHICS ORGANIZATION AND PROCEDURES PRIVACY...) The Office of Government Ethics or the other agency concerned will maintain an accounting of disclosures in cases where records about the data subject are disclosed from OGE's system of records except...

  19. Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations.

    PubMed

    T H Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

    2014-01-01

    The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures - 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

  20. Risk transfer and accountability in managed care organizations' carve-out contracts.

    PubMed

    Garnick, D W; Horgan, C M; Hodgkin, D; Merrick, E L; Goldin, D; Ritter, G; Skwara, K C

    2001-11-01

    This study examined characteristics of contracts between managed care organizations (MCOs) and managed behavioral health organizations (MBHOs) in terms of delegation of functions, financial arrangements between the MCO and the MBHO, and the use of performance standards. Nationally representative administrative and clinical information about the three largest types of commercial products offered by 434 MCOs in 60 market areas was gathered by telephone survey. These products comprised services provided by health maintenance organizations, preferred provider organizations, and point-of-service plans. Chi square tests were performed between pairings of all three types of products to ascertain differences in the degree to which claims processing, maintenance of provider networks, utilization management, case management, and quality improvement were delegated to MBHOs through specialty contracts among the various types of products. Contractual specifications about capitation arrangements, risk sharing, the use of performance standards, and final utilization review decisions were also compared. For all types of products, almost all the major functions were contracted by the MCO to the MBHO. Although most contracts assigned some risk for the costs of services to the MBHO, the degree of this risk varied by product type. Except in the case of preferred-provider organizations, a large number of performance standards were identified in MCOs' contracts with MBHOs, although financial incentives were rarely tied to such standards. MCOs that contract with MBHOs place major responsibility, both financial and administrative, on the vendors.

  1. Attention to surgeons and surgical care is largely missing from early medicare accountable care organizations.

    PubMed

    Dupree, James M; Patel, Kavita; Singer, Sara J; West, Mallory; Wang, Rui; Zinner, Michael J; Weissman, Joel S

    2014-06-01

    The Affordable Care Act supports the growth of accountable care organizations (ACOs) as a potentially powerful model for health care delivery and payment. The model focuses on primary care. However, surgeons and other specialists have a large role to play in caring for ACOs' patients. No studies have yet investigated the role of surgical care in the ACO model. Using case studies and a survey, we examined the early experience of fifty-nine Medicare-approved ACOs in providing surgical care. We found that ACOs have so far devoted little attention to surgical care. Instead, they have emphasized coordinating care for patients with chronic conditions and reducing unnecessary hospital readmissions and ED visits. In the years to come, ACOs will likely focus more on surgical care. Some ACOs have the ability to affect surgical practice patterns through referral pressures, but local market conditions may limit ACOs' abilities to alter surgeons' behavior. Policy makers, ACO administrators, and surgeons need to be aware of these trends because they have the potential to affect the surgical care provided to ACO patients as well as the success of ACOs themselves. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Twitter accounts followed by Congressional health staff.

    PubMed

    Grande, David; Meisel, Zachary F; Merchant, Raina M; Seymour, Jane; Gollust, Sarah E

    2017-07-01

    Although health policy research should inform policy making, the communication gap between researchers and policy makers limits successful translation. Social media represents a new opportunity to connect researchers and policy makers. Our objective was to assess who Congressional health policy staff follow on a major social media platform. Cross-sectional study. Our study measured Congressional health policy staff's use of Twitter and the types of individuals and organizations they follow. To focus on more influential Twitter accounts, we restricted our sample to those followed by at least 3 individual Congressional staff members. Of the 30,843 accounts followed by the 115 Congressional health policy staff, 1273 were potentially policy-related and followed by 3 or more staff. Of these, few were academically affiliated (2.4%) or explicitly health-related (5.6%) sites; many were general news media sources (50.9%) and political and governmental sources (36.4%). Health-focused accounts were frequently connected to the news media or government rather than academia. Top accounts followed (ie, highest quintile) were most likely to be national news organizations (odds ratio [OR], 5.88; 95% confidence interval [CI], 1.75-19.7) and elected officials (OR, 8.22; 95% CI, 1.75-38.6) compared with advocacy and interest groups. Health-related and academic sources are largely absent from the Twitter conversations with US Congressional health policy staff. Even within social media, traditional and political news media are important information intermediaries that researchers and journals should target to disseminate health policy evidence.

  3. Strategic relevance and accountability expectations: new perspectives for health care information technology design.

    PubMed

    Tan, J K; Modrow, R E

    1999-05-01

    In this article, we discuss the traditional systems analysis perspective on end-user information requirements analysis and extend it to merge with the new accountability expectations perspective to guide the future planning and design of health organization information systems. Underlying the strategic relevance of health care information technology (HCIT) are three critical questions: (1) What is the ideal HCIT model for the health organization in terms of achieving strategic expertise and competitive advantage? Specifically, how does this model link industry performance standards with organizational performance and accountability expectations? (2) How should the limitations of past HCIT models be reconciled to the benefits presented by the superior arrangement of the ideal model in the context of changing accountability expectations? (3) How should alternative HCIT solutions be evaluated in light of evidence-based accountability and organizational performance benchmarking? Insights into these questions will ensure that health care managers, HCIT practitioners and researchers can continue to focus on the most critical issues in harnessing today's fast-paced changing technologies for evolving strategically relevant, performance-based health organization systems.

  4. Predictors of Rural Health Clinics Managers' Willingness to Join Accountable Care Organizations

    PubMed Central

    T.H.Wan, Thomas; Masri, Maysoun Dimachkie; Ortiz, Judith

    2014-01-01

    Purpose The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics are responding to the ACO model. This research examines RHC managers' perceived benefits and barriers for implementing ACOs from an organizational ecology perspective. Methodology/Approach A survey was conducted in Spring of 2012 covering the present RHC network working infrastructures – 1) Organizational social network; 2) organizational care delivery structure; 3) ACO knowledge, perceived benefits, and perceived barriers; 4) quality and disease management programs; and 5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of ninety-one responses were received. Findings RHC managers' personal perceptions on ACO's benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis. Research limitations/implications The study is primarily focused in the Southeastern region of the U.S. The generalizability is limited to this region. The predictors of rural health clinics' participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act. Originality/Value of Paper Rural health clinics are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform

  5. Accountability in Community Colleges Using Stakeholder Theory

    ERIC Educational Resources Information Center

    Pitcher, Paula R.

    2012-01-01

    The purpose of the present study is to analyze stakeholder theory and its applicability to community college accountability. Community colleges have been using strategic planning as a management approach that includes the process of strategic action, and many organizations claim that they collaborate with their stakeholders during this process.…

  6. Holding Accountability Models Accountable

    ERIC Educational Resources Information Center

    Pyatte, Jeff A.

    1974-01-01

    This article provides an accurate account of the history of the Texarkana Project, the first attempt to demonstrate accountability in education by using the engineering model. Using the average per pupil expenditure as a basis for comparison, the cost of engineering in Texarkana is shown to be very high. (Author)

  7. Teaching Elementary Accounting to Non-Accounting Majors

    ERIC Educational Resources Information Center

    Lloyd, Cynthia B.; Abbey, Augustus

    2009-01-01

    A central recurring theme in business education is the optimal strategy for improving introductory accounting, the gateway subject of business education. For many students, especially non-accounting majors, who are required to take introductory accounting as a requirement of the curriculum, introductory accounting has become a major obstacle for…

  8. Audit Mechanisms for Provable Risk Management and Accountable Data Governance

    DTIC Science & Technology

    2012-09-04

    the same violation) and the effectiveness of policy interventions (e.g., data breach notification laws and government audits) in encouraging organizations to adopt accountable data governance practices.

  9. Accounts receivable reports: underutilized mining tools.

    PubMed

    Wallace, R

    1999-01-01

    There is gold to be found in accounts receivable reports for those willing to mine the data. The key is to know how to interpret the information buried within the numbers and use it to recover monies owed. This article identifies seven reports that should be staples in every organization committed to improving its overall collection performance. Also included are tips on understanding reports and implementing changes.

  10. Accounting Fundamentals for Non-Accountants

    EPA Pesticide Factsheets

    The purpose of this module is to provide an introduction and overview of accounting fundamentals for non-accountants. The module also covers important topics such as communication, internal controls, documentation and recordkeeping.

  11. The Legal Framework for Educational Privatization and Accountability.

    ERIC Educational Resources Information Center

    Kemerer, Frank R.; Maloney, Catherine

    This article explores how the law currently influences accountability in three different privatization contexts: (1) private schools operated independently of the state; (2) public schools operated by private organizations under charter or subcontract with government entities; and (3) private schools participating in publicly-funded voucher…

  12. Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics.

    PubMed

    Epstein, Arnold M; Jha, Ashish K; Orav, E John; Liebman, Daniel L; Audet, Anne-Marie J; Zezza, Mark A; Guterman, Stuart

    2014-01-01

    Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. Federal ACO programs for Medicare beneficiaries are now up and running, but little information is available about the baseline characteristics of early entrants. In this descriptive study we present data on the structural and market characteristics of these early ACOs and compare ACOs' patient populations, costs, and quality with those of their non-ACO counterparts at baseline. We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics. Our findings can be useful in interpreting the early results from the federal ACO programs and in establishing a baseline to assess the programs' development.

  13. Getting tough with home health accounts receivable.

    PubMed

    Cantone, L; Bullock, A

    2000-04-01

    Home health organizations seeking to improve the performance of their accounts receivable should concentrate first on establishing practices that promote the greatest percentage of clean claims and reviewing payments received to be sure rates paid are optimal. They also may find it worthwhile to survey their business office operations for potential improvements to key areas.

  14. Enhancing the Safe and Effective Management of Chronic Pain in Accountable Care Organization Primary Care Practices in Kentucky.

    PubMed

    Wubu, Selam; Hall, Laura Lee; Straub, Paula; Bair, Matthew J; Marsteller, Jill A; Hsu, Yea-Jen; Schneider, Doron; Hood, Gregory A

    Chronic pain is a prevalent chronic condition with significant burden and economic impact in the United States. Chronic pain is particularly abundant in primary care, with an estimated 52% of chronic pain patients obtaining care from primary care physicians (PCPs). However, PCPs often lack adequate training and have limited time and resources to effectively manage chronic pain. Chronic pain management is complex in nature because of high co-occurrence of psychiatric disorders and other medical comorbidities in patients. This article describes a quality improvement initiative conducted by the American College of Physicians (ACP), in collaboration with the Kentucky ACP Chapter, and the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, to enhance chronic pain management in 8 primary care practices participating in Accountable Care Organizations in Kentucky, with a goal of enhancing the screening, diagnosis, and treatment of patients with chronic pain.

  15. Accounting for social accountability: developing critiques of social accountability within medical education.

    PubMed

    Ritz, Stacey A; Beatty, Kathleen; Ellaway, Rachel H

    2014-01-01

    The concept of the social accountability of medical schools has garnered many followers, in response to a broad desire for greater social justice in health care. As its use has spread, the term 'social accountability' has become a meta-narrative for social justice and an inevitable and unquestionable good, while at the same time becoming increasingly ambiguous in its meaning and intent. In this article, we use the lenses of postmodernism and critical reflexivity to unpack the multiple meanings of social accountability. In our view, subjecting the concept of 'social accountability' to critique will enhance the ability to appraise the ways in which it is understood and enacted. We contend that critical reflexivity is necessary for social accountability to achieve its aspirations, and hence we must be prepared to become accountable not only for our actions, but also for the ideologies and discourses underlying them.

  16. The business of radiology: cost accounting.

    PubMed

    Camponovo, Ernest J

    2004-08-01

    Radiology practices confront questions of resource allocation every day. Unfortunately, practices frequently fail to adequately analyze revenues and expenses, which are at the heart of success or failure in any business endeavor. Cost allocation problems permeate nearly all aspects of cost analysis and accumulation and exist throughout all types of private-sector and public-sector organizations. "Managerial" or "cost" accounting is the discipline concerned with measuring and assigning the costs of delivering services or producing products. In contrast to financial accounting, management accounting produces relevant information for internal decision making and in general is designed to answer a firm's specific operational questions. Because costs play such a critical role in deriving and planning for revenues and profits, managerial accounting is in large part devoted to measuring and accumulating costs with the aims of control and continuous cost reduction. Because radiologists' salaries are at record highs, when accounting for a practice's clinical activities, such as the provision of mammography services, some allocation of radiologist costs themselves must be made, or the practice will not be able to achieve its goal of efficient allocation of resources. Whatever cost-accounting method is used should be specific enough to allow the differentiation of costs to as detailed a level as necessary for the strategic decision at hand. It is imperative that a practice use some rational method to gather and analyze costs and that management then use these data in decision making. Successful practices will be those most aware of their costs and the minimum acceptable reimbursements necessary for their success.

  17. Risk of inundation to coastal wetlands and soil organic carbon and organic nitrogen accounting in Louisiana, USA.

    PubMed

    Zhong, Biao; Xu, Y Jun

    2011-10-01

    Exceeding 1.2 million acres (4856 km(2)) since the 1930s, coastal wetland loss has been the most threatening environmental problem in Louisiana, United States. This study utilized high-resolution LiDAR (Light Detection and Ranging) and DEM (Digital Elevation Model) data sets to assess the risk of potential wetland loss due to future sea level rises, their spatial distribution, and the associated loss of soil organic carbon (SOC) and organic nitrogen (SON) estimated from the State Soil Geographic (STATSGO) Database and National Wetlands Inventory (NWI) digital data. Potential inundation areas were divided into five elevation scales: < 0 cm, 0-50 cm, 50-100 cm, 100-150 cm, and 150-200 cm above mean sea level. The study found that southeastern Louisiana on the Mississippi River Delta, specifically the Pontchartrain and Barataria Basins, are most vulnerable to sea-level rise induced inundation. Accordingly, approximately 42,264,600 t of SOC and 2,817,640 t of SON would be inundated by 2050 using an average wetland SOC density (203 t per hectare) for the inundation areas between 0 and 50 cm. The estimated annual SOC and SON loss from Louisiana's coast is 17% of annual organic carbon and 6-8% of annual organic nitrogen inputs from the Mississippi River.

  18. 77 FR 43542 - Cost Accounting Standards: Cost Accounting Standards 412 and 413-Cost Accounting Standards...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-25

    ... rule that revised Cost Accounting Standard (CAS) 412, ``Composition and Measurement of Pension Cost... Accounting Standards: Cost Accounting Standards 412 and 413--Cost Accounting Standards Pension Harmonization Rule AGENCY: Cost Accounting Standards Board, Office of Federal Procurement Policy, Office of...

  19. Using health information technology to manage a patient population in accountable care organizations.

    PubMed

    Wu, Frances M; Rundall, Thomas G; Shortell, Stephen M; Bloom, Joan R

    2016-06-20

    Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management.

  20. Accountability: A Watchword for University Administration in Nigeria

    ERIC Educational Resources Information Center

    Sofoluwe, Abayomi Olumade; Oduwaiye, Rhoda Olape; Ogundele, Michael Olarewaju; Kayode, David Jimoh

    2015-01-01

    The term accountability means different things to different people in different organizations. In the educational setting, the term is seen as liability to one's accomplishment in the educational system. The ever increasing needs of the universities and the dwindling resources available to them have forced university management and other…

  1. Government Accounting

    DTIC Science & Technology

    1999-06-22

    Commercial Industry • Financial Standards Accounting Board (GAAP) • Internal Revenue Service - Tax Accounting • DoD - Cost Accounting Standards...internal management control systems, managers shall focus on results, not process” Government Accounting • Intent EVM Accounting Criteria : – Record costs ...consistent with established budgets – Insure control of indirect costs – Insure disciplined accumulation of cost – Insure proper material accounting and

  2. Disruptive innovation in academic medical centers: balancing accountable and academic care.

    PubMed

    Stein, Daniel; Chen, Christopher; Ackerly, D Clay

    2015-05-01

    Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care.

  3. Recent Trends in Higher Education: Accountability, Efficiency, Technology, and Governance.

    ERIC Educational Resources Information Center

    Lahey, John L.; Griffith, Janice C.

    2002-01-01

    Discusses the impact of trends in higher education regarding increasing demands for accountability, greater financial efficiency, increasing use of technology, and changes in organization and governance. Discusses the implications for law schools. (EV)

  4. Benchmarking can add up for healthcare accounting.

    PubMed

    Czarnecki, M T

    1994-09-01

    In 1993, a healthcare accounting and finance benchmarking survey of hospital and nonhospital organizations gathered statistics about key common performance areas. A low response did not allow for statistically significant findings, but the survey identified performance measures that can be used in healthcare financial management settings. This article explains the benchmarking process and examines some of the 1993 study's findings.

  5. Inadequate Financial Accountability in California's Community College System.

    ERIC Educational Resources Information Center

    Commission on California State Government Organization and Economy, Sacramento.

    In August 1985, the Commission on California State Government Organization and Economy initiated a study of California's community college system to assess the adequacy of financial accountability in the system. Two hearings, interviews, and analyses of extensive data, yielded the following findings: (1) 25% of the community college districts had…

  6. Responding to Accountability Requirements while Promoting Program Improvement

    ERIC Educational Resources Information Center

    Guillen-Woods, Blanca Flor; Kaiser, Monica A.; Harrington, Maura J.

    2008-01-01

    The impact of No Child Left Behind (NCLB) is usually understood in relation to schools and districts, but the legislation has also affected community-based organizations that operate school-linked programs. This case study of an after-school program in California demonstrates how educational accountability systems that emphasize students' academic…

  7. Avoiding Scandal and Headlines with Ethics and Accountability

    ERIC Educational Resources Information Center

    Haubold, Glen; Throneberry, Angela

    2010-01-01

    Procedures, financial controls and reports, and leadership are the three major components that "set the tone" for an effective, accountable, and ethical organization. Procedures must be formally documented instead of passed down verbally on the premise that "we've always done it this way." Meaningful management reports should be developed and…

  8. Stewardship and accountability.

    PubMed

    Osborne, Karen; Osborne, Robert

    2005-01-01

    In March 2003 The Chronicle for Philanthropy reported a sea change in fund development. After 25 years of consistent research on donor motivation, a study came out with new information. Donors ranked on a scale of 1-10 what mattered most to them when considering giving. Until now, most donors reported that a belief in the mission of the organization and the desire to have an impact on the people served was their number one motivation. Certainly gratitude for life-saving or life-changing service made that belief in mission and impact that much more powerful as a motivation. Improving their community was consistently the number two reason for giving. But, according to the 2003 survey, something changed. Six of the 10 reasons involve stewardship and accountability.

  9. Decision-Making on Medical Innovations in a Changing Healthcare Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies

    PubMed Central

    Trosman, Julia R.; Weldon, Christine B.; Douglas, Michael P.; Deverka, Patricia A.; Watkins, John; Phillips, Kathryn A.

    2016-01-01

    Background New payment and care organization approaches, such as the Accountable Care Organization (ACO), are reshaping accountability and shifting risk, as well as decision-making, from payers to providers, under the Triple Aim of health reform. The Triple Aim calls for improving experience of care, improving health of populations and reducing healthcare costs. In the era of accelerating scientific advancement of personalized medicine and other innovations, it is critical to understand how the transition to the ACO model impacts decision-making on adoption and utilization of innovative technologies. Methods We interviewed representatives from ten private payers and six provider institutions involved in implementing the ACO model (i.e. ACOs) to understand changes, challenges and facilitators of decision-making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. Results We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs’ decision-making in terms of achieving a balance between the components of the Triple Aim – improving care experience, improving population health and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs’ decisions and ACOs’ insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients’ interest in personalized medicine. Conclusions As new payment models evolve, payers, ACOs and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous and transparent approaches to decision-making on medical innovations. PMID:28212967

  10. Manpower Goals Planning and Accountability. Research Report 34.

    ERIC Educational Resources Information Center

    Niehaus, R. J.; Nitterhouse, D.

    Based on previous application of goal programming models to manpower goals planning for large organizations, this paper structures the extensions from the planning process to the operations and control aspects of the management cycle. Emphasis is on the accountability necessary to make such a system an effective management control tool. In order…

  11. Strategic implementation and accountability: the case of the long-term care alliance.

    PubMed

    Seaman, Al; Elias, Maria; O'Neill, Bill; Yatabe, Karen

    2010-01-01

    A group of chief executives of long-term care homes formed an alliance in order to tap the resources residing within their management teams. Adopting a strategic implementation project based on a framework of accountability, the executives were able to better understand the uncertainties of the environment and potentially structure their strategic implementation to best use scarce resources. The framework of accountability allowed the homes to recognize the need for a strong business approach to long-term care. Communication improved throughout the organizations while systems and resources showed improved utilization. Quality became the driving force for all actions taken to move the organizations toward achieving their visions.

  12. Preventive care quality of Medicare Accountable Care Organizations: Associations of organizational characteristics with performance

    PubMed Central

    Albright, Benjamin B.; Lewis, Valerie A.; Ross, Joseph S.; Colla, Carrie H.

    2015-01-01

    Background Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for eight measures of preventive care quality. Objectives To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. Design Cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Results Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified two underlying factors among eight measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. Conclusions ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration. PMID:26759974

  13. Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance.

    PubMed

    Albright, Benjamin B; Lewis, Valerie A; Ross, Joseph S; Colla, Carrie H

    2016-03-01

    Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. This is a cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified 2 underlying factors among 8 measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.

  14. 18 CFR 367.1420 - Account 142, Customer accounts receivable.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 142, Customer... GAS ACT Balance Sheet Chart of Accounts Current and Accrued Assets § 367.1420 Account 142, Customer accounts receivable. (a) This account must include amounts due from customers for service, and for...

  15. Role of serial order in the impact of talker variability on short-term memory: testing a perceptual organization-based account.

    PubMed

    Hughes, Robert W; Marsh, John E; Jones, Dylan M

    2011-11-01

    In two experiments, we examined the impact of the degree of match between sequential auditory perceptual organization processes and the demands of a short-term memory task (memory for order vs. item information). When a spoken sequence of digits was presented so as to promote its perceptual partitioning into two distinct streams by conveying it in alternating female (F) and male (M) voices (FMFMFMFM)--thereby disturbing the perception of true temporal order--recall of item order was greatly impaired (as compared to recall of item identity). Moreover, an order error type consistent with the formation of voice-based streams was committed more quickly in the alternating-voice condition (Exp. 1). In contrast, when the perceptual organization of the sequence mapped well onto an optimal two-group serial rehearsal strategy--by presenting the two voices in discrete clusters (FFFFMMMM)--order, but not item, recall was enhanced (Exp. 2). The results are consistent with the view that the degree of compatibility between perceptual and deliberate sequencing processes is a key determinant of serial short-term memory performance. Alternative accounts of talker variability effects in short-term memory, based on the concept of a dedicated phonological short-term store and a capacity-limited focus of attention, are also reviewed.

  16. Excel in the Accounting Curriculum: Perceptions from Accounting Professors

    ERIC Educational Resources Information Center

    Ramachandran Rackliffe, Usha; Ragland, Linda

    2016-01-01

    Public accounting firms emphasize the importance of accounting graduates being proficient in Excel. Since many accounting graduates often aspire to work in public accounting, a question arises as to whether there should be an emphasis on Excel in accounting education. The purpose of this paper is to specifically look at this issue by examining…

  17. Configuration of management accounting information system for multi-stage manufacturing

    NASA Astrophysics Data System (ADS)

    Mkrtychev, S. V.; Ochepovsky, A. V.; Enik, O. A.

    2018-05-01

    The article presents an approach to configuration of a management accounting information system (MAIS) that provides automated calculations and the registration of normative production losses in multi-stage manufacturing. The use of MAIS with the proposed configuration at the enterprises of textile and woodworking industries made it possible to increase the accuracy of calculations for normative production losses and to organize accounting thereof with the reference to individual stages of the technological process. Thus, high efficiency of multi-stage manufacturing control is achieved.

  18. Ethical Dilemmas in Financial Reporting Situations and the Preferred Mode of Resolution of Ethical Conflicts as Taken by Certified and Noncertified Management Accountants in Organizations with Perceived Different Ethical Work Climates.

    ERIC Educational Resources Information Center

    McKenna, John N.

    1995-01-01

    Responses from 37.7% of 491 chief financial officers surveyed revealed a majority of organizational climates based on law and codes. Most believed their organizations attempted sound financial reporting and ethical operation. Certified accountants perceived a greater likelihood of the occurrence of ethical dilemmas than did noncertified…

  19. 76 FR 14110 - Order Regarding Review of FASB Accounting Support Fee for 2011 Under Section 109 of the Sarbanes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-15

    ... recognize, as generally accepted for purposes of the securities laws, any accounting principles established... policy statement concluding that the Financial Accounting Standards Board (``FASB'') and its parent organization, the Financial Accounting Foundation (``FAF''), satisfied the criteria for an accounting standard...

  20. From clinical integration to accountable care.

    PubMed

    Shields, Mark

    2011-01-01

    Four key challenges to reforming health care organizations can be addressed by a clinical integration model patterned after Advocate Physician Partners (APP). These challenges are: predominance of small group practices, dominant fee-for-service reimbursement methods, weaknesses of the traditional hospital medical staff structure and a need to partner with commercial insurance companies. APP has demonstrated teamwork between 3800 physicians and hospitals to improve quality, patient safety and cost-effectiveness. Building on this model, an innovative contract with Blue Cross Blue Shield of Illinois serves as a prototype for a commercial Accountable Care Organization. For this contract to succeed, APP must outperform the market competition. To accomplish this, APP has implemented strategies to reduce readmissions, avoid unnecessary admissions and emergency room visits, expand primary care access, and enhance quality and patient safety.

  1. A strategic tension for hospitals moving upstream: Cede control but maintain accountability.

    PubMed

    Taylor, Lauren A; Berchuck, Caroline M; Barnett, Katherine Gergen

    2018-07-01

    Health systems are focusing attention on the role that social determinants of health (SDOH) can and should play in health care delivery. This is especially true among accountable care organizations (ACOs) and Medicaid ACOs in particular. In crafting SDOH strategies, senior leadership teams may face an organizational tension in aiming to cede control over dollars, data and patient experience to community-based organizations (CBOs) while also maintaining financial accountability for health outcomes. We review the history of neighborhood health centers (NHCs) in order to foreshadow the types of critiques ACOs are likely to face in working with CBOs. We conclude by suggesting a several strategies by which ACOs may be lessen accountability concerns, including raising the issue with regulators, using low-risk dollars to fund joint-work, working through an intermediary, providing technical assistance and viewing the relationship as a partnership rather than contract. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. International Accounting and the Accounting Educator.

    ERIC Educational Resources Information Center

    Laribee, Stephen F.

    The American Assembly of Collegiate Schools of Business (AACSB) has been instrumental in internationalizing the accounting curriculum by means of accreditation requirements and standards. Colleges and universities have met the AACSB requirements either by providing separate international accounting courses or by integrating international topics…

  3. 17 CFR 17.01 - Identification of special accounts, volume threshold accounts, and omnibus accounts.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 1 2014-04-01 2014-04-01 false Identification of special accounts, volume threshold accounts, and omnibus accounts. 17.01 Section 17.01 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION REPORTS BY REPORTING MARKETS, FUTURES COMMISSION MERCHANTS, CLEARING MEMBERS, AND FOREIGN BROKERS §...

  4. Depreciation Accounting in the Uniform Chart of Accounts.

    DTIC Science & Technology

    1982-12-01

    footage of building occupied. Reason( s ) for Compute full cost of Rate setting, cash accounting for patient care flow generation and fund- depreciation ing... Horngren , Charles T., Cost Accounting ; A Managerial Emphasis, Prentice-Hall Inc., 1972. 32. Sawyer, Lawrence B., The Practice of Modern Internal Auditing...Awd ubtlft) S . TYPE or RE PORT a PE*IoO CovIERWO Master’s Thesis; Depreciation Accounting in the Uniform Dembr18 Chart of Accounts .PSOiwON.EORlumm

  5. End-of-Life Care Planning in Accountable Care Organizations: Associations with Organizational Characteristics and Capabilities.

    PubMed

    Ahluwalia, Sangeeta C; Harris, Benjamin J; Lewis, Valerie A; Colla, Carrie H

    2018-06-01

    To measure the extent to which accountable care organizations (ACOs) have adopted end-of-life (EOL) care planning processes and characterize those ACOs that have established processes related to EOL. This study uses data from three waves (2012-2015) of the National Survey of ACOs. Respondents were 397 ACOs participating in Medicare, Medicaid, and commercial ACO contracts. This is a cross-sectional survey study using multivariate ordered logit regression models. We measured the extent to which the ACO had adopted EOL care planning processes as well as organizational characteristics, including care management, utilization management, health informatics, and shared decision-making capabilities, palliative care, and patient-centered medical home experience. Twenty-one percent of ACOs had few or no EOL care planning processes, 60 percent had some processes, and 19.6 percent had advanced processes. ACOs with a hospital in their system (OR: 3.07; p = .01), and ACOs with advanced care management (OR: 1.43; p = .02), utilization management (OR: 1.58, p = .00), and shared decision-making capabilities (OR: 16.3, p = .000) were more likely to have EOL care planning processes than those with no hospital or few to no capabilities. There remains considerable room for today's ACOs to increase uptake of EOL care planning, possibly by leveraging existing care management, utilization management, and shared decision-making processes. © Health Research and Educational Trust.

  6. Organizing for Instruction in Education Systems and School Organizations: "How" the Subject Matters

    ERIC Educational Resources Information Center

    Spillane, James P.; Hopkins, Megan

    2013-01-01

    Teaching, the core technology of schooling, is an essential consideration in investigations of education systems and school organizations. Taking teaching seriously as an explanatory variable in research on education systems and organizations necessitates moving beyond treating it as a unitary practice, so as to take account of the school subjects…

  7. Analyzing the Operation of Performance-Based Accountability Systems for Public Services. Technical Report

    ERIC Educational Resources Information Center

    Camm, Frank; Stecher, Brian M.

    2010-01-01

    Empirical evidence of the effects of performance-based public management is scarce. This report describes a framework used to organize available empirical information on one form of performance-based management, a performance-based accountability system (PBAS). Such a system identifies individuals or organizations that must change their behavior…

  8. Accounting Employers' Expectations--The Ideal Accounting Graduates

    ERIC Educational Resources Information Center

    Low, Mary; Botes, Vida; Rue, David Dela; Allen, Jackie

    2016-01-01

    This research examined what accounting employers are seeking in their "ideal" accounting graduate and sought to provide clarification on the "expectation gap" between what accounting employers require in their graduates, and the skills these graduates are exhibiting. Adopting a qualitative research method, this research paper…

  9. New Frontiers: Training Forensic Accountants within the Accounting Program

    ERIC Educational Resources Information Center

    Ramaswamy, Vinita

    2007-01-01

    Accountants have recently been subject to very unpleasant publicity following the collapse of Enron and other major companies. There has been a plethora of accounting failures and accounting restatements of falsified earnings, with litigations and prosecutions taking place every day. As the FASB struggles to tighten the loopholes in accounting,…

  10. Price-Transparency and Cost Accounting

    PubMed Central

    Eakin, Cynthia; Fischer, Katrina

    2015-01-01

    Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. PMID:25862425

  11. 76 FR 53378 - Cost Accounting Standards: Accounting for Insurance Costs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-26

    ... Accounting Standards: Accounting for Insurance Costs AGENCY: Cost Accounting Standards Board (Board), Office... Discontinuation of Rulemaking. SUMMARY: The Office of Federal Procurement Policy (OFPP), Cost Accounting Standards... development of an amendment to Cost Accounting Standard (CAS) 416 regarding the use of the term ``catastrophic...

  12. Organizing for Accountability

    ERIC Educational Resources Information Center

    Bennis, Warren

    1975-01-01

    A college president challenges personnel administrators to play a leadership role in human resource management. Notes the need for career development programs for middle managers particularly and recommends an organizational development approach to faculty and staff career development. (JT)

  13. 18 CFR 367.9200 - Account 920, Administrative and general salaries.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., Administrative and general salaries. 367.9200 Section 367.9200 Conservation of Power and Water Resources FEDERAL... and general salaries. (a) This account must include salaries, wages, bonuses and other consideration... detailed records subdividing salaries and wages by departments or other functional organization units. ...

  14. 18 CFR 367.1840 - Account 184, Clearing accounts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 184, Clearing accounts. 367.1840 Section 367.1840 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... POWER ACT AND NATURAL GAS ACT UNIFORM SYSTEM OF ACCOUNTS FOR CENTRALIZED SERVICE COMPANIES SUBJECT TO...

  15. 18 CFR 367.2320 - Account 232, Accounts payable.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 232, Accounts payable. 367.2320 Section 367.2320 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... POWER ACT AND NATURAL GAS ACT UNIFORM SYSTEM OF ACCOUNTS FOR CENTRALIZED SERVICE COMPANIES SUBJECT TO...

  16. Accounting Education for the Non-Accountant.

    ERIC Educational Resources Information Center

    Spiceland, J. David

    1983-01-01

    The nondegree Certified Public Accountant (CPA) preparation program at Memphis State University is an accelerated series of eight credit courses in accounting designed for those who have earned a nonaccounting degree and need the technical training and required courses to enable them to take the CPA examination in Tennessee. (JOW)

  17. Accountability, California Style: Counting or Accounting?

    ERIC Educational Resources Information Center

    Russell, Michael; Higgins, Jennifer; Raczek, Anastasia

    2004-01-01

    Across the nation and at nearly all levels of our educational system, efforts to hold schools accountable for student learning dominate strategies for improving the quality of education. At both the national and state level, student testing stands at the center of educational accountability programs, such that schools are effectively held…

  18. Organic chemistry on Titan

    NASA Technical Reports Server (NTRS)

    Chang, S.; Scattergood, T.; Aronowitz, S.; Flores, J.

    1978-01-01

    Observations of nonequilibrium phenomena on the Saturn satellite Titan indicate the occurrence of organic chemical evolution. Greenhouse and thermal inversion models of Titan's atmosphere provide environmental constraints within which various pathways for organic chemical synthesis are assessed. Experimental results and theoretical modeling studies suggest that the organic chemistry of the satellite may be dominated by two atmospheric processes: energetic-particle bombardment and photochemistry. Reactions initiated in various levels of the atmosphere by cosmic ray, Saturn wind, and solar wind particle bombardment of a CH4 - N2 atmospheric mixture can account for the C2-hydrocarbons, the UV-visible-absorbing stratospheric haze, and the reddish color of the satellite. Photochemical reactions of CH4 can also account for the presence of C2-hydrocarbons. In the lower Titan atmosphere, photochemical processes will be important if surface temperatures are sufficiently high for gaseous NH3 to exist. Hot H-atom reactions initiated by photo-dissociation of NH3 can couple the chemical reactions of NH3 and CH4 and produce organic matter.

  19. 76 FR 81295 - Cost Accounting Standards: Cost Accounting Standards 412 and 413-Cost Accounting Standards...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-27

    ... accounting standards governing measurement, assignment, and allocation of costs to contracts with the United... contracting parties; Measurement of pension costs must be objectively verifiable; Accounting rules must keep... cost accounting that preclude their use for the appropriate measurement, assignment and allocation of...

  20. A Review of Financial Accounting Fraud Detection based on Data Mining Techniques

    NASA Astrophysics Data System (ADS)

    Sharma, Anuj; Kumar Panigrahi, Prabin

    2012-02-01

    With an upsurge in financial accounting fraud in the current economic scenario experienced, financial accounting fraud detection (FAFD) has become an emerging topic of great importance for academic, research and industries. The failure of internal auditing system of the organization in identifying the accounting frauds has lead to use of specialized procedures to detect financial accounting fraud, collective known as forensic accounting. Data mining techniques are providing great aid in financial accounting fraud detection, since dealing with the large data volumes and complexities of financial data are big challenges for forensic accounting. This paper presents a comprehensive review of the literature on the application of data mining techniques for the detection of financial accounting fraud and proposes a framework for data mining techniques based accounting fraud detection. The systematic and comprehensive literature review of the data mining techniques applicable to financial accounting fraud detection may provide a foundation to future research in this field. The findings of this review show that data mining techniques like logistic models, neural networks, Bayesian belief network, and decision trees have been applied most extensively to provide primary solutions to the problems inherent in the detection and classification of fraudulent data.

  1. The Social Organization of School Counseling in the Era of Standards-Based Accountability

    ERIC Educational Resources Information Center

    Dorsey, Alexander C.

    2011-01-01

    The reform policies of standards-based accountability, as outlined in NCLB, impede the functioning of school counseling programs and the delivery of services to students. Although recent studies have focused on the transformation of the school counseling profession, a gap exists in the literature with regard to how the experiences of school…

  2. What Can the U.S. Learn from National Health Accounting Elsewhere?

    PubMed Central

    Berman, Peter

    1999-01-01

    The United States is typically seen as an outlier in health spending when compared with other advanced nations. Recent improvements in health accounting in lower- and middle-income countries suggest some common features with the high and pluralistic spending in the United States. The author discusses recent developments and findings in health accounting outside the Organization for Economic Cooperation and Development (OECD) and their relevance for the United States. He argues that we should expect more fruitful exchanges in the future. PMID:11481785

  3. Decision Making on Medical Innovations in a Changing Health Care Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies.

    PubMed

    Trosman, Julia R; Weldon, Christine B; Douglas, Michael P; Deverka, Patricia A; Watkins, John B; Phillips, Kathryn A

    2017-01-01

    New payment and care organization approaches, such as those of accountable care organizations (ACOs), are reshaping accountability and shifting risk, as well as decision making, from payers to providers, within the Triple Aim context of health reform. The Triple Aim calls for improving experience of care, improving health of populations, and reducing health care costs. To understand how the transition to the ACO model impacts decision making on adoption and use of innovative technologies in the era of accelerating scientific advancement of personalized medicine and other innovations. We interviewed representatives from 10 private payers and 6 provider institutions involved in implementing the ACO model (i.e., ACOs) to understand changes, challenges, and facilitators of decision making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs' decision making in terms of achieving a balance between the components of the Triple Aim-improving care experience, improving population health, and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs' decisions and ACOs' insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients' interest in personalized medicine. As new payment models evolve, payers, ACOs, and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous, and transparent approaches to decision making on medical innovations. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. The Conflict of Professionals in Bureaucratic Organizations

    ERIC Educational Resources Information Center

    Sorensen, James E.; Sorensen, Thomas L.

    1974-01-01

    A study of 264 certified public accountants in large public accounting firms showed that when professionals work in a professional-bureaucratic organization, conflict and deprivation result with predictable consequences such as job dissatisfaction and job migration. (Author)

  5. Organic chemistry on Titan

    NASA Technical Reports Server (NTRS)

    Chang, S.; Scattergood, T.; Aronowitz, S.; Flores, J.

    1979-01-01

    Features taken from various models of Titan's atmosphere are combined in a working composite model that provides environmental constraints within which different pathways for organic chemical synthesis are determined. Experimental results and theoretical modeling suggest that the organic chemistry of the satellite is dominated by two processes: photochemistry and energetic particle bombardment. Photochemical reactions of CH4 in the upper atmosphere can account for the presence of C2 hydrocarbons. Reactions initiated at various levels of the atmosphere by cosmic rays, Saturn 'wind', and solar wind particle bombardment of a CH4-N2 atmospheric mixture can account for the UV-visible absorbing stratospheric haze, the reddish appearance of the satellite, and some of the C2 hydrocarbons. In the lower atmosphere photochemical processes will be important if surface temperatures are sufficiently high for gaseous NH3 to exist. It is concluded that the surface of Titan may contain ancient or recent organic matter (or both) produced in the atmosphere.

  6. Active Accountability: A Cross-Case Study of Two Schools Negotiating Improvement, Change, and Organizational Integrity

    ERIC Educational Resources Information Center

    Gasoi, Emily

    2012-01-01

    Educational accountability has come to be defined almost exclusively in terms of schools meeting external standards of improvement. Building on a body of scholarship that presents schools as complex organizations, this research proposes that a more robust understanding of educational accountability must be grounded in practitioners perceptions of…

  7. Being accountable for care of the poor. CHA's social accountability budget helps facilities keep track of charitable activity.

    PubMed

    Trocchio, J; Eckels, T

    1989-06-01

    The Catholic Health Association's social accountability budget is a set of tools to help Catholic healthcare facilities plan for, administer, and report benefits provided to their communities, especially the poor. It defines a full roster of community benefits that a healthcare organization may provide. The benefits fall into three major categories: activities and services, policies and procedures, and community leadership. The social accountability budget also presents guidelines for assessing the facility's existing services, activities, policies, and procedures and discusses how the facility can conduct or be part of a community needs assessment. Information collected through this assessment is used in the planning and budgeting processes. This ensures that uncompensated care and charitable services receive consideration along with traditional planning and budgeting items. Additional guidelines show the facility how to track and measure its services to the community. The final step, often absent from Catholic healthcare facilities' programs, is reporting community benefits.

  8. Evaluating the Impact of an Accountable Care Organization on Population Health: The Quasi-Experimental Design of the German Gesundes Kinzigtal.

    PubMed

    Pimperl, Alexander; Schulte, Timo; Mühlbacher, Axel; Rosenmöller, Magdalena; Busse, Reinhard; Groene, Oliver; Rodriguez, Hector P; Hildebrandt, Helmut

    2017-06-01

    A central goal of accountable care organizations (ACOs) is to improve the health of their accountable population. No evidence currently links ACO development to improved population health. A major challenge to establishing the evidence base for the impact of ACOs on population health is the absence of a theoretically grounded, robust, operationally feasible, and meaningful research design. The authors present an evaluation study design, provide an empirical example, and discuss considerations for generating the evidence base for ACO implementation. A quasi-experimental study design using propensity score matching in combination with small-scale exact matching is implemented. Outcome indicators based on claims data were constructed and analyzed. Population health is measured by using a range of mortality indicators: mortality ratio, age at time of death, years of potential life lost/gained, and survival time. The application is assessed using longitudinal data from Gesundes Kinzigtal, one of the leading population-based ACOs in Germany. The proposed matching approach resulted in a balanced control of observable differences between the intervention (ACO) and control groups. The mortality indicators used indicate positive results. For example, 635.6 fewer years of potential life lost (2005.8 vs. 2641.4; t-test: sig. P < 0.05*) in the ACO intervention group (n = 5411) attributable to the ACO, also after controlling for a potential (indirect) immortal time bias by excluding the first half year after enrollment from the outcome measurement. This empirical example of the impact of a German ACO on population health can be extended to the evaluation of ACOs and other integrated delivery models of care.

  9. 18 CFR 367.9050 - Account 905, Miscellaneous customer accounts expenses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 905, Miscellaneous customer accounts expenses. 367.9050 Section 367.9050 Conservation of Power and Water Resources..., Miscellaneous customer accounts expenses. (a) This account must include the cost of labor, materials used and...

  10. Landfilling of waste: accounting of greenhouse gases and global warming contributions.

    PubMed

    Manfredi, Simone; Tonini, Davide; Christensen, Thomas H; Scharff, Heijo

    2009-11-01

    Accounting of greenhouse gas (GHG) emissions from waste landfilling is summarized with the focus on processes and technical data for a number of different landfilling technologies: open dump (which was included as the worst-case-scenario), conventional landfills with flares and with energy recovery, and landfills receiving low-organic-carbon waste. The results showed that direct emissions of GHG from the landfill systems (primarily dispersive release of methane) are the major contributions to the GHG accounting, up to about 1000 kg CO(2)-eq. tonne( -1) for the open dump, 300 kg CO(2)-eq. tonne( -1) for conventional landfilling of mixed waste and 70 kg CO(2)-eq. tonne(-1) for low-organic-carbon waste landfills. The load caused by indirect, upstream emissions from provision of energy and materials to the landfill was low, here estimated to be up to 16 kg CO(2)-eq. tonne(-1). On the other hand, utilization of landfill gas for electricity generation contributed to major savings, in most cases, corresponding to about half of the load caused by direct GHG emission from the landfill. However, this saving can vary significantly depending on what the generated electricity substitutes for. Significant amounts of biogenic carbon may still be stored within the landfill body after 100 years, which here is counted as a saved GHG emission. With respect to landfilling of mixed waste with energy recovery, the net, average GHG accounting ranged from about -70 to 30 kg CO(2)-eq. tonne(- 1), obtained by summing the direct and indirect (upstream and downstream) emissions and accounting for stored biogenic carbon as a saving. However, if binding of biogenic carbon was not accounted for, the overall GHG load would be in the range of 60 to 300 kg CO(2)-eq. tonne( -1). This paper clearly shows that electricity generation as well as accounting of stored biogenic carbon are crucial to the accounting of GHG of waste landfilling.

  11. Accountability.

    ERIC Educational Resources Information Center

    Lashway, Larry

    1999-01-01

    This issue reviews publications that provide a starting point for principals looking for a way through the accountability maze. Each publication views accountability differently, but collectively these readings argue that even in an era of state-mandated assessment, principals can pursue proactive strategies that serve students' needs. James A.…

  12. Cost Accounting and Accountability for Early Education Programs for Handicapped Children.

    ERIC Educational Resources Information Center

    Gingold, William

    The paper offers some basic information for making decisions about allocating and accounting for resources provided to young handicapped children. Sections address the following topics: reasons for costing, audiences for cost accounting and accountability information, and a process for cost accounting and accountability (defining cost categories,…

  13. Computerised Accounting Software; A Curriculum That Enhances an Accounting Programme

    ERIC Educational Resources Information Center

    Machera, Robert P.; Machera, Precious C.

    2017-01-01

    There has been an outcry in commerce and industry about students who fail to perform in the accounting department due to lack of "practical accounting skills". It is from this background that the researchers were motivated to investigate the impact of a Computerised Accounting Software Curriculum that enhances an Accounting Programme. At…

  14. Counting, accounting, and accountability: Helen Verran's relational empiricism.

    PubMed

    Kenney, Martha

    2015-10-01

    Helen Verran uses the term 'relational empiricism' to describe situated empirical inquiry that is attentive to the relations that constitute its objects of study, including the investigator's own practices. Relational empiricism draws on and reconfigures Science and Technology Studies' traditional concerns with reflexivity and relationality, casting empirical inquiry as an important and non-innocent world-making practice. Through a reading of Verran's postcolonial projects in Nigeria and Australia, this article develops a concept of empirical and political 'accountability' to complement her relational empiricism. In Science and an African Logic, Verran provides accounts of the relations that materialize her empirical objects. These accounts work to decompose her original objects, generating new objects that are more promising for the specific postcolonial contexts of her work. The process of decomposition is part of remaining accountable for her research methods and accountable to the worlds she is working in and writing about. This is a practice of narrating relations and learning to tell better technoscientific stories. What counts as better, however, is not given, but is always contextual and at stake. In this way, Verran acts not as participant-observer, but as participant-storyteller, telling stories to facilitate epistemic flourishing within and as part of a historically located community of practice. The understanding of accountability that emerges from this discussion is designed as a contribution, both practical and evocative, to the theoretical toolkit of Science and Technology Studies scholars who are interested in thinking concretely about how we can be more accountable to the worlds we study.

  15. School Accountability.

    ERIC Educational Resources Information Center

    Evers, Williamson M., Ed.; Walberg, Herbert J., Ed.

    This book presents the perspectives of experts from the fields of history, economics, political science, and psychology on what is known about accountability, what still needs to be learned, what should be done right now, and what should be avoided in devising accountability systems. The common myths about accountability are dispelled and how it…

  16. Accounting Issues: An Essay Series. Part II--Accounts Receivable

    ERIC Educational Resources Information Center

    Laux, Judith A.

    2007-01-01

    This is the second in a series of articles designed to help academics refocus the introductory accounting course on the theoretical underpinnings of accounting. Intended as a supplement for the principles course, this article connects the asset Accounts Receivable to the essential theoretical constructs, discusses the inherent tradeoffs and…

  17. Solving Accounting Problems: Differences between Accounting Experts and Novices.

    ERIC Educational Resources Information Center

    Marshall, P. Douglas

    2002-01-01

    Performance of 90 accounting experts (faculty and practitioners) and 60 novices (senior accounting majors) was compared. Experts applied more accounting principles to solving problems. There were no differences in types of principles applied and no correlation between (1) principles applied and number of breadth comments or (2) importance placed…

  18. Advanced Imaging Utilization and Cost Savings Among Medicare Shared Savings Program Accountable Care Organizations: An Initial Exploratory Analysis.

    PubMed

    Rosenkrantz, Andrew B; Duszak, Richard

    2018-03-01

    The purpose of this study was to explore associations between CT and MRI utilization and cost savings achieved by Medicare Shared Savings Program (MSSP)-participating accountable care organizations (ACOs). Summary data were obtained for all MSSP-participating ACOs (n = 214 in 2013; n = 333 in 2014). Multivariable regressions were performed to assess associations of CT and MRI utilization with ACOs' total savings and reaching minimum savings rates to share in Medicare savings. In 2014, 54.4% of ACOs achieved savings, meeting minimum rates to share in savings in 27.6%. Independent positive predictors of total savings included beneficiary risk scores (β = +20,265,720, P = .003) and MRI events (β = +19,964, P = .018) but not CT events (β = +2,084, P = .635). Independent positive predictors of meeting minimum savings rates included beneficiary risk scores (odds ratio = 2108, P = .001) and MRI events (odds ratio = 1.008, P = .002), but not CT events (odds ratio = 1.002, P = .289). Measures not independently associated with savings were total beneficiaries; beneficiaries' gender, age, race or ethnicity; and Medicare enrollment type (P > .05). For ACOs with 2013 and 2014 data, neither increases nor decreases in CT and MRI events between years were associated with 2014 total savings or meeting savings thresholds (P ≥ .466). Higher MRI utilization rates were independently associated with small but significant MSSP ACO savings. The value of MRI might relate to the favorable impact of appropriate advanced imaging utilization on downstream outcomes and other resource utilization. Because MSSP ACOs represent a highly select group of sophisticated organizations subject to rigorous quality and care coordination standards, further research will be necessary to determine if these associations are generalizable to other health care settings. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  19. Organic Micro/Nanoscale Lasers.

    PubMed

    Zhang, Wei; Yao, Jiannian; Zhao, Yong Sheng

    2016-09-20

    Micro/nanoscale lasers that can deliver intense coherent light signals at (sub)wavelength scale have recently captured broad research interest because of their potential applications ranging from on-chip information processing to high-throughput sensing. Organic molecular materials are a promising kind of ideal platform to construct high-performance microlasers, mainly because of their superiority in abundant excited-state processes with large active cross sections for high gain emissions and flexibly assembled structures for high-quality microcavities. In recent years, ever-increasing efforts have been dedicated to developing such organic microlasers toward low threshold, multicolor output, broadband tunability, and easy integration. Therefore, it is increasingly important to summarize this research field and give deep insight into the structure-property relationships of organic microlasers to accelerate the future development. In this Account, we will review the recent advances in organic miniaturized lasers, with an emphasis on tunable laser performances based on the tailorable microcavity structures and controlled excited-state gain processes of organic materials toward integrated photonic applications. Organic π-conjugated molecules with weak intermolecular interactions readily assemble into regular nanostructures that can serve as high-quality optical microcavities for the strong confinement of photons. On the basis of rational material design, a series of optical microcavities with different structures have been controllably synthesized. These microcavity nanostructures can be endowed with effective four-level dynamic gain processes, such as excited-state intramolecular charge transfer, excited-state intramolecular proton transfer, and excimer processes, that exhibit large dipole optical transitions for strongly active gain behaviors. By tailoring these excited-state processes with molecular/crystal engineering and external stimuli, people have effectively

  20. Colorful Accounting

    ERIC Educational Resources Information Center

    Warrick, C. Shane

    2006-01-01

    As instructors of accounting, we should take an abstract topic (at least to most students) and connect it to content known by students to help increase the effectiveness of our instruction. In a recent semester, ordinary items such as colors, a basketball, and baseball were used to relate the subject of accounting. The accounting topics of account…

  1. Randomly Accountable

    ERIC Educational Resources Information Center

    Kane, Thomas J.; Staiger, Douglas O.; Geppert, Jeffrey

    2002-01-01

    The accountability debate tends to devolve into a battle between the pro-testing and anti-testing crowds. When it comes to the design of a school accountability system, the devil is truly in the details. A well-designed accountability plan may go a long way toward giving school personnel the kinds of signals they need to improve performance.…

  2. Plasticity-Driven Self-Organization under Topological Constraints Accounts for Non-random Features of Cortical Synaptic Wiring

    PubMed Central

    Miner, Daniel; Triesch, Jochen

    2016-01-01

    Understanding the structure and dynamics of cortical connectivity is vital to understanding cortical function. Experimental data strongly suggest that local recurrent connectivity in the cortex is significantly non-random, exhibiting, for example, above-chance bidirectionality and an overrepresentation of certain triangular motifs. Additional evidence suggests a significant distance dependency to connectivity over a local scale of a few hundred microns, and particular patterns of synaptic turnover dynamics, including a heavy-tailed distribution of synaptic efficacies, a power law distribution of synaptic lifetimes, and a tendency for stronger synapses to be more stable over time. Understanding how many of these non-random features simultaneously arise would provide valuable insights into the development and function of the cortex. While previous work has modeled some of the individual features of local cortical wiring, there is no model that begins to comprehensively account for all of them. We present a spiking network model of a rodent Layer 5 cortical slice which, via the interactions of a few simple biologically motivated intrinsic, synaptic, and structural plasticity mechanisms, qualitatively reproduces these non-random effects when combined with simple topological constraints. Our model suggests that mechanisms of self-organization arising from a small number of plasticity rules provide a parsimonious explanation for numerous experimentally observed non-random features of recurrent cortical wiring. Interestingly, similar mechanisms have been shown to endow recurrent networks with powerful learning abilities, suggesting that these mechanism are central to understanding both structure and function of cortical synaptic wiring. PMID:26866369

  3. Accounting for the dissociating properties of organic chemicals in LCIA: an uncertainty analysis applied to micropollutants in the assessment of freshwater ecotoxicity.

    PubMed

    Morais, Sérgio Alberto; Delerue-Matos, Cristina; Gabarrell, Xavier

    2013-03-15

    In life cycle impact assessment (LCIA) models, the sorption of the ionic fraction of dissociating organic chemicals is not adequately modeled because conventional non-polar partitioning models are applied. Therefore, high uncertainties are expected when modeling the mobility, as well as the bioavailability for uptake by exposed biota and degradation, of dissociating organic chemicals. Alternative regressions that account for the ionized fraction of a molecule to estimate fate parameters were applied to the USEtox model. The most sensitive model parameters in the estimation of ecotoxicological characterization factors (CFs) of micropollutants were evaluated by Monte Carlo analysis in both the default USEtox model and the alternative approach. Negligible differences of CFs values and 95% confidence limits between the two approaches were estimated for direct emissions to the freshwater compartment; however the default USEtox model overestimates CFs and the 95% confidence limits of basic compounds up to three orders and four orders of magnitude, respectively, relatively to the alternative approach for emissions to the agricultural soil compartment. For three emission scenarios, LCIA results show that the default USEtox model overestimates freshwater ecotoxicity impacts for the emission scenarios to agricultural soil by one order of magnitude, and larger confidence limits were estimated, relatively to the alternative approach. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. A Review of the Factors Associated with the Adoption of Accounting Information Systems in Gulf Countries.

    PubMed

    Hammour, Hadal; Househ, Mowafa; Razzak, Hira Abdul

    2017-01-01

    This review attempts to elucidate the significance of accounting information systems within healthcare settings in the Gulf regions. Information and communication technologies (ICT) has provided accounting system the ability to help an organization use and develop computerized systems to record and track financial transactions. Accounting information systems, if well implemented, can permit healthcare sectors in the Gulf regions to produce reports that can support the decision making process. Additional abilities of an accounting information systems include faster processing, enriched accuracy, amplified functionality, and improved external reporting. Training of hospital staff can help in enhancing the use of accounting information systems in gulf hospitals.

  5. Renewing Professional Organizations and Action Learning

    ERIC Educational Resources Information Center

    Mullen, Carol A.

    2011-01-01

    This account concerns the renewal of established professional organizations though action learning. In order to revitalize one national organization, an executive group of leaders committed to co-leading and co-learning through a friendly, computer-supported governance structure. Manifestations of our work together were an accelerated…

  6. 12 CFR 701.35 - Share, share draft, and share certificate accounts.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... AFFECTING CREDIT UNIONS ORGANIZATION AND OPERATION OF FEDERAL CREDIT UNIONS § 701.35 Share, share draft, and share certificate accounts. (a) Federal credit unions may offer share, share draft, and share...) A Federal credit union shall accurately represent the terms and conditions of its share, share draft...

  7. 12 CFR 701.35 - Share, share draft, and share certificate accounts.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... AFFECTING CREDIT UNIONS ORGANIZATION AND OPERATION OF FEDERAL CREDIT UNIONS § 701.35 Share, share draft, and share certificate accounts. (a) Federal credit unions may offer share, share draft, and share...) A Federal credit union shall accurately represent the terms and conditions of its share, share draft...

  8. 12 CFR 701.35 - Share, share draft, and share certificate accounts.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... AFFECTING CREDIT UNIONS ORGANIZATION AND OPERATION OF FEDERAL CREDIT UNIONS § 701.35 Share, share draft, and share certificate accounts. (a) Federal credit unions may offer share, share draft, and share...) A Federal credit union shall accurately represent the terms and conditions of its share, share draft...

  9. Contract Design, Supply Chain Complexity, and Accountability in Federal Contracts

    DTIC Science & Technology

    2016-04-30

    understanding how organizations, policy makers, and citizens use information to make decisions and influence public and organizational policy. He has...qÜáêíÉÉåíÜ=^ååì~ä= ^Åèìáëáíáçå=oÉëÉ~êÅÜ= póãéçëáìã= qÜìêëÇ~ó=pÉëëáçåë= sçäìãÉ=ff= = Contract Design, Supply Chain Complexity, and Accountability in Federal...Executive Officer, PEO IEW&S Contract Design, Supply Chain Complexity, and Accountability in Federal Contracts Adam Eckerd, Assistant Professor

  10. 48 CFR 9904.406 - Cost accounting standard-cost accounting period.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard-cost accounting period. 9904.406 Section 9904.406 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT...

  11. Assessment of the Accounting and Joint Accounting/Computer Information Systems Programs.

    ERIC Educational Resources Information Center

    Appiah, John; Cernigliaro, James; Davis, Jeffrey; Gordon, Millicent; Richards, Yves; Santamaria, Fernando; Siegel, Annette; Lytle, Namy; Wharton, Patrick

    This document presents City University of New York LaGuardia Community College's Department of Accounting and Managerial Studies assessment of its accounting and joint accounting/computer information systems programs report, and includes the following items: (1) description of the mission and goals of the Department of Accounting and Managerial…

  12. Accounting for noise when clustering biological data.

    PubMed

    Sloutsky, Roman; Jimenez, Nicolas; Swamidass, S Joshua; Naegle, Kristen M

    2013-07-01

    Clustering is a powerful and commonly used technique that organizes and elucidates the structure of biological data. Clustering data from gene expression, metabolomics and proteomics experiments has proven to be useful at deriving a variety of insights, such as the shared regulation or function of biochemical components within networks. However, experimental measurements of biological processes are subject to substantial noise-stemming from both technical and biological variability-and most clustering algorithms are sensitive to this noise. In this article, we explore several methods of accounting for noise when analyzing biological data sets through clustering. Using a toy data set and two different case studies-gene expression and protein phosphorylation-we demonstrate the sensitivity of clustering algorithms to noise. Several methods of accounting for this noise can be used to establish when clustering results can be trusted. These methods span a range of assumptions about the statistical properties of the noise and can therefore be applied to virtually any biological data source.

  13. Exploring the practical themes for medical education social accountability in Iran.

    PubMed

    Ahmady, Soleiman; Akbari Lakeh, Maryam

    2015-01-01

    The purpose of this paper is to explore themes for enhancing socially accountability in medical education. Medical education in Iran experience new challenges due to the enormous influence of changes in technology, development of new methods of teaching and learning, student requirements, patient management, financial credit constraints, and social and economic developments. For responding to these, use of strategic thinking in order to make appropriate decisions is the only solution. Strategic plans need to formulate practical guides which can help accountable to people's reasonable expectations. For this qualitative study, along with the 14(th)national conference on Medical Education in Iran, the opinions of experts were obtained during seven expert panels' group discussions, each lasting four hours and including 10 participants. Data were collected by audiotapes, which were then transcribed. Data analyzed using a thematic content analysis approach. Peer and member checking during analysis and data triangulation from other recent studies were used to increase the findings' trustworthiness. Among more than hundred meaning units groups identified the following eight main themes as affecting the social accountable medical education in Iran: organization of responsive education councils; development of community based courses; development in field training; organization of educational processes; homogeneity in educational rules and regulations; budget management, educational outcomes; educational programs in departments and groups. This study have found the main themes that might affecting social accountable medical education in Iran, where Iranian policymakers should consider those when plan to make changes in medical education and could potentially adopt the proven useful policies and strategies of other countries.

  14. Trends in Accounting Education: Decreasing Accounting Anxiety and Promoting New Methods

    ERIC Educational Resources Information Center

    Buckhaults, Jessica; Fisher, Diane

    2011-01-01

    In this paper, authors (a) identified accounting anxiety for the educator and the student as a possible explanation for the decline in accounting education and (b) investigated new methods for teaching accounting at the secondary and postsecondary levels that will increase interest in accounting education as well as decrease educator and student…

  15. Incorporating Sarbanes-Oxley into a College Accounting Curriculum: Lessons Learned

    ERIC Educational Resources Information Center

    Ragan, Joseph M.; Rizman, Brian J.; Gregory, Jonathan T.

    2007-01-01

    This paper attempts to identify the ways and give examples of how Sarbanes-Oxley compliance can be taught in real time using the SAP R/3 system and the many lessons derived from the experience. The Sarbanes-Oxley Act significantly impacts CEO's, CFO's and public accountants. It also applies to all levels of management. Organizations and their…

  16. 12 CFR 701.35 - Share, share draft, and share certificate accounts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Share, share draft, and share certificate... AFFECTING CREDIT UNIONS ORGANIZATION AND OPERATION OF FEDERAL CREDIT UNIONS § 701.35 Share, share draft, and share certificate accounts. (a) Federal credit unions may offer share, share draft, and share...

  17. 12 CFR 701.35 - Share, share draft, and share certificate accounts.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Share, share draft, and share certificate... AFFECTING CREDIT UNIONS ORGANIZATION AND OPERATION OF FEDERAL CREDIT UNIONS § 701.35 Share, share draft, and share certificate accounts. (a) Federal credit unions may offer share, share draft, and share...

  18. Inclusion in Public Administration: Developing the Concept of Inclusion within a School of Accounts and Administration

    ERIC Educational Resources Information Center

    dos Santos, Mônica Pereira; de Melo, Sandra Cordeiro; Santiago, Mylene Cristina; Nazareth, Paula

    2017-01-01

    This study originates from ongoing action research that aims to develop institutional opportunities to reflect on and take decisions about inclusion in the School of Accounts and Administration of Rio de Janeiro's State Accounts Office. The research was organized in three phases. The first phase was an inservice course to sensitize professionals…

  19. 77 FR 202 - Federal Acquisition Regulation; Updated Financial Accounting Standards Board Accounting References

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-03

    ... 9000-AM00 Federal Acquisition Regulation; Updated Financial Accounting Standards Board Accounting... accounting standards owing to the Financial Accounting Standards Board's Accounting Standards Codification of Generally Accepted Accounting Principles. DATES: Effective Date: February 2, 2012. FOR FURTHER INFORMATION...

  20. Analysis of Membrane Lipids of Airborne Micro-Organisms

    NASA Technical Reports Server (NTRS)

    MacNaughton, Sarah

    2006-01-01

    A method of characterization of airborne micro-organisms in a given location involves (1) large-volume filtration of air onto glass-fiber filters; (2) accelerated extraction of membrane lipids of the collected micro-organisms by use of pressurized hot liquid; and (3) identification and quantitation of the lipids by use of gas chromatography and mass spectrometry. This method is suitable for use in both outdoor and indoor environments; for example, it can be used to measure airborne microbial contamination in buildings ("sick-building syndrome"). The classical approach to analysis of airborne micro-organisms is based on the growth of cultureable micro-organisms and does not provide an account of viable but noncultureable micro-organisms, which typically amount to more than 90 percent of the micro-organisms present. In contrast, the present method provides an account of all micro-organisms, including cultureable, noncultureable, aerobic, and anaerobic ones. The analysis of lipids according to this method makes it possible to estimate the number of viable airborne micro-organisms present in the sampled air and to obtain a quantitative profile of the general types of micro-organisms present along with some information about their physiological statuses.

  1. Financial Accounting for Local and State School Systems: Standard Receipt and Expenditure Accounts. State Educational Records and Reports Series Handbook II. Bulletin, 1957, No. 4

    ERIC Educational Resources Information Center

    Reason, Paul L., Comp.; White, Alpheus L., Comp.

    1957-01-01

    This handbook is the basic guide to financial accounting for local and State school systems in the United States. It is the second in a series of four handbooks in the State of Educational Records and Reports Series undertaken at the request of a number of national organizations. Handbook I, "The Common Core of State Educational Information," was…

  2. Activity-Based Costing in a Service Organization

    DTIC Science & Technology

    1993-06-01

    environments, very little research has been done in service organizations. This thesis is a comparative analysis of a tradional cost accounting system with an...activity-based cost accounting system in a medium-sized mass transit system. The purpose of the analysis was to determine whether activity-based... accounting techniques can effectively be applied in a service industry. In addition, a goal for the thesis was to determine which costing system reports a

  3. Human Resource Accounting.

    DTIC Science & Technology

    1984-12-01

    costs . The goal of this thesis is to help the Portuguese Navy in formulating a formal and coherent approach to its human resource accounting , and in so...ABSTRACT Human Resource Accounting means accounting for people as an organizational asset. It is the measurement of the cost and value of people to the...29 II.HUMAN RESOURCE COSTS . . . . . . . . . . . 30 A. CONCEPTS OF COST AND MEASUREMENT METHODS . . . 30 1. Accounting Concepts of Costs

  4. Multimedia and Management Accounting: Adding Creativity to Accounting.

    ERIC Educational Resources Information Center

    Heisz, Mary A.; Blake, Catherine M.; Andrusyszyn, Mary-Anne

    2000-01-01

    Describes the development of an interactive multimedia accounting module for management accounting at the University of Western Ontario. Discusses results of a study of graduate students that investigated the influence of the module on learning and retention compared to traditional instruction as well as students' perceptions of the module.…

  5. 18 CFR 367.5000 - Accounts 500-598, Electric operation and maintenance accounts.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Accounts 500-598... Accounts 500-598, Electric operation and maintenance accounts. Service companies must use accounts 500 through 598 in part 101 of this chapter. ...

  6. 18 CFR 367.5000 - Accounts 500-598, Electric operation and maintenance accounts.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Accounts 500-598... Accounts 500-598, Electric operation and maintenance accounts. Service companies must use accounts 500 through 598 in part 101 of this chapter. ...

  7. 18 CFR 367.5000 - Accounts 500-598, Electric operation and maintenance accounts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Accounts 500-598... Accounts 500-598, Electric operation and maintenance accounts. Service companies must use accounts 500 through 598 in part 101 of this chapter. ...

  8. 18 CFR 367.5000 - Accounts 500-598, Electric operation and maintenance accounts.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Accounts 500-598... Accounts 500-598, Electric operation and maintenance accounts. Service companies must use accounts 500 through 598 in part 101 of this chapter. ...

  9. 18 CFR 367.5000 - Accounts 500-598, Electric operation and maintenance accounts.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Accounts 500-598... Accounts 500-598, Electric operation and maintenance accounts. Service companies must use accounts 500 through 598 in part 101 of this chapter. ...

  10. Organisms as natural purposes: the contemporary evolutionary perspective.

    PubMed

    Walsh, D M

    2006-12-01

    Kant's conception of organisms as natural purposes raises a challenge to the adequacy of mechanistic explanation in biology. Certain features of organisms appear to be inexplicable by appeal to mechanical law alone. Some biological phenomena, it seems, can only be accounted for teleologically. Contemporary evolutionary biology has by and large ignored this challenge. It is widely held that Darwin's theory of natural selection gives us an adequate, wholly mechanical account of the nature of organisms. In contemporary biology, the category of the organism plays virtually no explanatory role. Contemporary evolutionary biology is a science of sub-organismal entities-replicators. I argue that recent advances in developmental biology demonstrate the inadequacy of sub-organismal mechanism. The category of the organism, construed as a 'natural purpose' should play an ineliminable role in explaining ontogenetic development and adaptive evolution. According to Kant the natural purposiveness of organisms cannot be demonstrated to be an objective principle in nature, nor can purposiveness figure in genuine explain. I attempt to argue, by appeal to recent work on self-organization, that the purposiveness of organisms is a natural phenomenon, and, by appeal to the apparatus of invariance explanation, that biological purposiveness provides genuine, ineliminable biological explanations.

  11. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program.

    PubMed

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish

    2012-09-01

    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  12. A Neo-Aristotelian Account of Education, Justice, and the Human Good

    ERIC Educational Resources Information Center

    Curren, Randall

    2013-01-01

    This article sketches the contours of a neo-Aristotelian account of education, justice, and the human good, organized around a sequence of three increasingly distinctive features of the Aristotelian understanding of respect for persons as rational beings. The first and second of these features bear on important aspects of educational justice,…

  13. Community Organizing for School Reform in Philadelphia.

    ERIC Educational Resources Information Center

    Mediratta, Kavitha; Fruchter, Norm; Gross, Barbara; Keller, Christine Donis; Bonilla, Mili

    Pennsylvania's Philadelphia School District has a high percentage of minority, bilingual, and low-income students and suffers from low student achievement, chaotic instructional organization, teacher shortage, dilapidated school facilities, and lack of accountability. Six community organizing groups are working with parents and youth for local and…

  14. Person-Organization Commitment: Bonds of Internal Consumer in the Context of Non-profit Organizations.

    PubMed

    Juaneda-Ayensa, Emma; Clavel San Emeterio, Mónica; González-Menorca, Carlos

    2017-01-01

    From an Organizational Behavior perspective, it is important to recognize the links generated between individuals and the organization that encourage a desire for permanence. After more than a half century of research, Organizational Commitment remains one of the open questions in the Psychology of Organizations. It is considered an essential factor for explaining individual behavior in the organization such as satisfaction, turnover intention, or loyalty. In this paper, we analyze different contributions regarding the nature of the bond between the individual and the organization. Taking into account the peculiarities of Non-profit Organizations, we present different interpretation for later validation, comparing results from the Confirmatory Factor Analysis of the four models obtained using exploratory factor analysis, both conducted on a sample of 235 members of Non-profit Organizations.

  15. Person-Organization Commitment: Bonds of Internal Consumer in the Context of Non-profit Organizations

    PubMed Central

    Juaneda-Ayensa, Emma; Clavel San Emeterio, Mónica; González-Menorca, Carlos

    2017-01-01

    From an Organizational Behavior perspective, it is important to recognize the links generated between individuals and the organization that encourage a desire for permanence. After more than a half century of research, Organizational Commitment remains one of the open questions in the Psychology of Organizations. It is considered an essential factor for explaining individual behavior in the organization such as satisfaction, turnover intention, or loyalty. In this paper, we analyze different contributions regarding the nature of the bond between the individual and the organization. Taking into account the peculiarities of Non-profit Organizations, we present different interpretation for later validation, comparing results from the Confirmatory Factor Analysis of the four models obtained using exploratory factor analysis, both conducted on a sample of 235 members of Non-profit Organizations. PMID:28775699

  16. The Accounting Principles Instructor's Influence on Students' Decision To Major in Accounting.

    ERIC Educational Resources Information Center

    Mauldin, Shawn; Crain, John L.; Mounce, Patricia H.

    2000-01-01

    A survey of 81 accounting majors, 60 business majors, 12 nonbusiness majors, and 13 undecided students in accounting principles courses found that accounting principles instructors play the most significant role in the decision to major in accounting. Many students decide to major during their first principles course. (SK)

  17. Gender disparity in organ donation.

    PubMed

    Steinman, Judith L

    2006-12-01

    Organ donation is affected by legal, cultural, religious, and racial factors, as well as by health considerations. Although organs in and of themselves are gender neutral and can be exchanged between the sexes, women account for up to two thirds of all organ donations. There are no clear reasons why women are more willing to undergo the risks of surgery than are men, nor is this gender disparity mirrored in the demand for donated organs. More men than women are recipients, and women are less likely to complete the necessary steps to receive donated organs. Internationally, ethical concern has been focused on possible human rights violations in the harvesting of organs from prisoners and, in poor countries, on the trafficking of organs from girls and women who are expected to financially help their families by selling their organs.

  18. A call for government accountability to achieve national self-sufficiency in organ donation and transplantation.

    PubMed

    Delmonico, Francis L; Domínguez-Gil, Beatriz; Matesanz, Rafael; Noel, Luc

    2011-10-15

    Roughly 100,000 patients worldwide undergo organ transplantation annually, but many other patients remain on waiting lists. Transplantation rates vary substantially across countries. Affluent patients in nations with long waiting lists do not always wait for donations from within their own countries. Commercially driven transplantation, however, does not always ensure proper medical care of recipients or donors, and might lengthen waiting times for resident patients or increase the illegal and unethical purchase of organs from living donors. Governments should systematically address the needs of their countries according to a legal framework. Medical strategies to prevent end-stage organ failure must also be implemented. In view of the Madrid Resolution, the Declaration of Istanbul, and the 63rd World Health Assembly Resolution, a new paradigm of national self-sufficiency is needed. Each country or region should strive to provide a sufficient number of organs from within its own population, guided by WHO ethics principles. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Accounting for quality: on the relationship between accounting and quality improvement in healthcare.

    PubMed

    Pflueger, Dane

    2015-04-23

    Accounting-that is, standardized measurement, public reporting, performance evaluation and managerial control-is commonly seen to provide the core infrastructure for quality improvement in healthcare. Yet, accounting successfully for quality has been a problematic endeavor, often producing dysfunctional effects. This has raised questions about the appropriate role for accounting in achieving quality improvement. This paper contributes to this debate by contrasting the specific way in which accounting is understood and operationalized for quality improvement in the UK National Health Service (NHS) with findings from the broadly defined 'social studies of accounting' literature and illustrative examples. This paper highlights three significant differences between the way that accounting is understood to operate in the dominant health policy discourse and recent healthcare reforms, and in the social studies of accounting literature. It shows that accounting does not just find things out, but makes them up. It shows that accounting is not simply a matter of substance, but of style. And it shows that accounting does not just facilitate, but displaces, control. The illumination of these differences in the way that accounting is conceptualized helps to diagnose why accounting interventions often fail to produce the quality improvements that were envisioned. This paper concludes that accounting is not necessarily incompatible with the ambition of quality improvement, but that it would need to be understood and operationalized in new ways in order to contribute to this end. Proposals for this new way of advancing accounting are discussed. They include the cultivation of overlapping and even conflicting measures of quality, the evaluation of accounting regimes in terms of what they do to practice, and the development of distinctively skeptical calculative cultures.

  20. Accounting History in Undergraduate Introductory Financial Accounting Courses: An Exploratory Study.

    ERIC Educational Resources Information Center

    Williams, Satina V.; Schwartz, Bill N.

    2002-01-01

    Accounting faculty surveyed (n=45) did not overwhelmingly support incorporating accounting history into introductory courses, despite Accounting Education Change Commission recommendations. They did not support a separate course or believe history would attract more students. Attitudes of those already including history did not differ greatly from…

  1. The good of non-sentient entities: Organisms, artifacts, and synthetic biology.

    PubMed

    Basl, John; Sandler, Ronald

    2013-12-01

    Synthetic organisms are at the same time organisms and artifacts. In this paper we aim to determine whether such entities have a good of their own, and so are candidates for being directly morally considerable. We argue that the good of non-sentient organisms is grounded in an etiological account of teleology, on which non-sentient organisms can come to be teleologically organized on the basis of their natural selection etiology. After defending this account of teleology, we argue that there are no grounds for excluding synthetic organisms from having a good also grounded in their teleological organization. However, this comes at a cost; traditional artifacts will also be seen as having a good of their own. We defend this as the best solution to the puzzle about what to say about the good of synthetic organisms. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. A Comparative Study of the Perceptions of Accounting Educators and Accountants on Skills Required of Accounting Education Graduates in Automated Offices

    ERIC Educational Resources Information Center

    Nwokike, Felicia Ogonnia; Eya, Gloria Mgboyibo

    2015-01-01

    The study dealt with perception of accounting educators and senior accountants on skills required of accounting education graduates for effective job performance in automated offices. The study adopted a descriptive research design.The population consisted of 149 respondents, made up of 80 accounting educators in public tertiary institutions and…

  3. 18 CFR 367.1460 - Account 146, Accounts receivable from associate companies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... POWER ACT AND NATURAL GAS ACT Balance Sheet Chart of Accounts Current and Accrued Assets § 367.1460... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 146, Accounts receivable from associate companies. 367.1460 Section 367.1460 Conservation of Power and Water Resources...

  4. 18 CFR 367.2340 - Account 234, Accounts payable to associate companies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... POWER ACT AND NATURAL GAS ACT Balance Sheet Chart of Accounts Current and Accrued Liabilities § 367.2340... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 234, Accounts payable to associate companies. 367.2340 Section 367.2340 Conservation of Power and Water Resources...

  5. A Harmonious Accounting Duo?

    ERIC Educational Resources Information Center

    Schapperle, Robert F.; Hardiman, Patrick F.

    1992-01-01

    Accountants have urged "harmonization" of standards between the Governmental Accounting Standards Board and the Financial Accounting Standards Board, recommending similar reporting of like transactions. However, varying display of similar accounting events does not necessarily indicate disharmony. The potential for problems because of…

  6. 76 FR 8989 - Federal Acquisition Regulation; Updated Financial Accounting Standards Board Accounting References

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-16

    ... Acquisition Regulation; Updated Financial Accounting Standards Board Accounting References AGENCIES... Acquisition Regulation (FAR) to update references to authoritative accounting standards owing to the Financial... Accounting Principles (GAAP) (``Codification of GAAP''). DATES: Interested parties should submit written...

  7. Toward defining and measuring social accountability in graduate medical education: a stakeholder study.

    PubMed

    Reddy, Anjani T; Lazreg, Sonia A; Phillips, Robert L; Bazemore, Andrew W; Lucan, Sean C

    2013-09-01

    Since 1965, Medicare has publically financed graduate medical education (GME) in the United States. Given public financing, various advisory groups have argued that GME should be more socially accountable. Several efforts are underway to develop accountability measures for GME that could be tied to Medicare payments, but it is not clear how to measure or even define social accountability. We explored how GME stakeholders perceive, define, and measure social accountability. Through purposive and snowball sampling, we completed semistructured interviews with 18 GME stakeholders from GME training sites, government agencies, and health care organizations. We analyzed interview field notes and audiorecordings using a flexible, iterative, qualitative group process to identify themes. THREE THEMES EMERGED IN REGARDS TO DEFINING SOCIAL ACCOUNTABILITY: (1) creating a diverse physician workforce to address regional needs and primary care and specialty shortages; (2) ensuring quality in training and care to best serve patients; and (3) providing service to surrounding communities and the general public. All but 1 stakeholder believed GME institutions have a responsibility to be socially accountable. Reported barriers to achieving social accountability included training time constraints, financial limitations, and institutional resistance. Suggestions for measuring social accountability included reviewing graduates' specialties and practice locations, evaluating curricular content, and reviewing program services to surrounding communities. Most stakeholders endorsed the concept of social accountability in GME, suggesting definitions and possible measures that could inform policy makers calls for increased accountability despite recognized barriers.

  8. Evaluating a Pay-for-Performance Program for Medicaid Children in an Accountable Care Organization.

    PubMed

    Gleeson, Sean; Kelleher, Kelly; Gardner, William

    2016-03-01

    Pay for performance (P4P) is a mechanism by which purchasers of health care offer greater financial rewards to physicians for improving processes or outcomes of care. To our knowledge, P4P has not been studied within the context of a pediatric accountable care organization (ACO). To determine whether P4P promotes pediatric performance improvement in primary care physicians. This retrospective cohort study was conducted from January 1, 2010, to December 31, 2013. A differences-in-differences design was used to test whether P4P improved physician performance in an ACO serving Medicaid children. Data were obtained from 2966 physicians and 323,812 patients. Three groups of physicians were identified: (1) community physicians who received the P4P incentives, (2) nonincentivized community physicians, and (3) nonincentivized physicians employed at a hospital. Pay for performance. Healthcare Effectiveness Data Information Set measure rates for preventive care, chronic care, and acute care primary care services. We examined 21 quality measures, 14 of which were subject to P4P incentives. There were 203 incentivized physicians, 2590 nonincentivized physicians, and 173 nonincentivized hospital physicians. Among them, the incentivized community physicians had greater improvements in performance than the nonincentivized community physicians on 2 of 2 well visits (largest difference was for adolescent well care: odds ratio, 1.05; 99.88% CI, 1.02-1.08), 3 of 10 immunization-incentivized measures (largest difference was for inactivated polio vaccine: odds ratio, 1.14; 99.88% CI, 1.07-1.21), and 2 nonincentivized measures (largest difference was for rotavirus: odds ratio, 1.11; 99.88% CI, 1.04-1.18). The employed physician group at the hospital had greater improvements in performance than the incentivized community physicians on 8 of 14 incentivized measures and 1 of 7 nonincentivized measures (largest difference was for hepatitis A vaccine: odds ratio, 0.34; 99.88% CI, 0

  9. Sustaining Reliability on Accountability Measures at The Johns Hopkins Hospital.

    PubMed

    Pronovost, Peter J; Holzmueller, Christine G; Callender, Tiffany; Demski, Renee; Winner, Laura; Day, Richard; Austin, J Matthew; Berenholtz, Sean M; Miller, Marlene R

    2016-02-01

    In 2012 Johns Hopkins Medicine leaders challenged their health system to reliably deliver best practice care linked to nationally vetted core measures and achieve The Joint Commission Top Performer on Key Quality Measures ®program recognition and the Delmarva Foundation award. Thus, the Armstrong Institute for Patient Safety and Quality implemented an initiative to ensure that ≥96% of patients received care linked to measures. Nine low-performing process measures were targeted for improvement-eight Joint Commission accountability measures and one Delmarva Foundation core measure. In the initial evaluation at The Johns Hopkins Hospital, all accountability measures for the Top Performer program reached the required ≥95% performance, gaining them recognition by The Joint Commission in 2013. Efforts were made to sustain performance of accountability measures at The Johns Hopkins Hospital. Improvements were sustained through 2014 using the following conceptual framework: declare and communicate goals, create an enabling infrastructure, engage clinicians and connect them in peer learning communities, report transparently, and create accountability systems. One part of the accountability system was for teams to create a sustainability plan, which they presented to senior leaders. To support sustained improvements, Armstrong Institute leaders added a project management office for all externally reported quality measures and concurrent reviewers to audit performance on care processes for certain measure sets. The Johns Hopkins Hospital sustained performance on all accountability measures, and now more than 96% of patients receive recommended care consistent with nationally vetted quality measures. The initiative methods enabled the transition of quality improvement from an isolated project to a way of leading an organization.

  10. Women Accountants in Practicing Accounting Firms: Their Status, Investments and Returns

    ERIC Educational Resources Information Center

    Okpechi, Simeon O.; Belmasrour, Rachid

    2011-01-01

    In the past twenty years, the number of qualified women accountants in the U.S. has outstripped that of men according to American Institute of Certified Public Accountants; yet these women occupy few strategic positions in accounting firms. Retention has been a major issue. This study explores how the perception of their status, investments and…

  11. Research Assessments and Rankings: Accounting for Accountability in "Higher Education Ltd"

    ERIC Educational Resources Information Center

    Singh, Geeta

    2008-01-01

    Over the past two decades, higher education in advanced capitalist societies has undergone a process of radical "reform". A key element of this reform has been the introduction of a number of accounting-based techniques in the pursuit of improved accountability and transparency. While the "old" accounting was to do with stewardship, the "new"…

  12. Do accountable care organizations (ACOs) help or hinder primary care physicians' ability to deliver high-quality care?

    PubMed

    Berenson, Robert A; Burton, Rachel A; McGrath, Megan

    2016-09-01

    Many view advanced primary care models such as the patient-centered medical home as foundational for accountable care organizations (ACOs), but it remains unclear how these two delivery reforms are complementary and how they may produce conflict. The objective of this study was to identify how joining an ACO could help or hinder a primary care practice's efforts to deliver high-quality care. This qualitative study involved interviews with a purposive sample of 32 early adopters of advanced primary care and/or ACO models, drawn from across the U.S. and conducted in mid-2014. Interview notes were coded using qualitative data analysis software, permitting topic-specific queries which were then summarized. Respondents perceived many potential benefits of joining an ACO, including care coordination staff, data analytics, and improved communication with other providers. However, respondents were also concerned about added "bureaucratic" requirements, referral restrictions, and a potential inability to recoup investments in practice improvements. Interviewees generally thought joining an ACO could complement a practice's efforts to deliver high-quality care, yet noted some concerns that could undermine these synergies. Both the advantages and disadvantages of joining an ACO seemed exacerbated for small practices, since they are most likely to benefit from additional resources yet are most likely to chafe under added bureaucratic requirements. Our identification of the potential pros and cons of joining an ACO may help providers identify areas to examine when weighing whether to enter into such an arrangement, and may help ACOs identify potential areas for improvement. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Microporoelastic Modeling of Organic-Rich Shales

    NASA Astrophysics Data System (ADS)

    Khosh Sokhan Monfared, S.; Abedi, S.; Ulm, F. J.

    2014-12-01

    Organic-rich shale is an extremely complex, naturally occurring geo-composite. The heterogeneous nature of organic-rich shale and its anisotropic behavior pose grand challenges for characterization, modeling and engineering design The intricacy of organic-rich shale, in the context of its mechanical and poromechanical properties, originates in the presence of organic/inorganic constituents and their interfaces as well as the occurrence of porosity and elastic anisotropy, at multiple length scales. To capture the contributing mechanisms, of 1st order, responsible for organic-rich shale complex behavior, we introduce an original approach for micromechanical modeling of organic-rich shales which accounts for the effect of maturity of organics on the overall elasticity through morphology considerations. This morphology contribution is captured by means of an effective media theory that bridges the gap between immature and mature systems through the choice of system's microtexture; namely a matrix-inclusion morphology (Mori-Tanaka) for immature systems and a polycrystal/granular morphology for mature systems. Also, we show that interfaces play a role on the effective elasticity of mature, organic-rich shales. The models are calibrated by means of ultrasonic pulse velocity measurements of elastic properties and validated by means of nanoindentation results. Sensitivity analyses using Spearman's Partial Rank Correlation Coefficient shows the importance of porosity and Total Organic Carbon (TOC) as key input parameters for accurate model predictions. These modeling developments pave the way to reach a "unique" set of clay properties and highlight the importance of depositional environment, burial and diagenetic processes on overall mechanical and poromechanical behavior of organic-rich shale. These developments also emphasize the importance of understanding and modeling clay elasticity and organic maturity on the overall rock behavior which is of critical importance for a

  14. Accounting for non-independent detection when estimating abundance of organisms with a Bayesian approach

    USGS Publications Warehouse

    Martin, Julien; Royle, J. Andrew; MacKenzie, Darryl I.; Edwards, Holly H.; Kery, Marc; Gardner, Beth

    2011-01-01

    Summary 1. Binomial mixture models use repeated count data to estimate abundance. They are becoming increasingly popular because they provide a simple and cost-effective way to account for imperfect detection. However, these models assume that individuals are detected independently of each other. This assumption may often be violated in the field. For instance, manatees (Trichechus manatus latirostris) may surface in turbid water (i.e. become available for detection during aerial surveys) in a correlated manner (i.e. in groups). However, correlated behaviour, affecting the non-independence of individual detections, may also be relevant in other systems (e.g. correlated patterns of singing in birds and amphibians). 2. We extend binomial mixture models to account for correlated behaviour and therefore to account for non-independent detection of individuals. We simulated correlated behaviour using beta-binomial random variables. Our approach can be used to simultaneously estimate abundance, detection probability and a correlation parameter. 3. Fitting binomial mixture models to data that followed a beta-binomial distribution resulted in an overestimation of abundance even for moderate levels of correlation. In contrast, the beta-binomial mixture model performed considerably better in our simulation scenarios. We also present a goodness-of-fit procedure to evaluate the fit of beta-binomial mixture models. 4. We illustrate our approach by fitting both binomial and beta-binomial mixture models to aerial survey data of manatees in Florida. We found that the binomial mixture model did not fit the data, whereas there was no evidence of lack of fit for the beta-binomial mixture model. This example helps illustrate the importance of using simulations and assessing goodness-of-fit when analysing ecological data with N-mixture models. Indeed, both the simulations and the goodness-of-fit procedure highlighted the limitations of the standard binomial mixture model for aerial

  15. Tips for medical practice success in the upcoming accountable care era.

    PubMed

    Bobbitt, Julian D

    2012-01-01

    Due to the unsustainable cost of healthcare, the movement to accountable care will be inevitable. This author predicts that recent Medicare Accountable Care Organization (ACO) regulations will energize ACO development. There are specific practical strategies every medical practice leader should know in order to navigate this new healthcare environment successfully. There is a window of opportunity, which will not stay open long, to control a medical practice's destiny in molding a fair, sustainable, and successful ACO. Not being prepared and defaulting to the status quo through passivity is also a choice that promises more work for less compensation for medical practices. The choice is clear, and the blueprint for success is available.

  16. Toward Reflective Accountability: Using NSSE for Accountability and Transparency

    ERIC Educational Resources Information Center

    McCormick, Alexander C.

    2009-01-01

    Accountability pressures in higher education are not new; they are part of an enduring public policy discourse about the costs and benefits, both individual and social, of higher education. What is relatively new, however, is the prominent place that issues of accountability now occupy on the nation's higher education agenda. There is an important…

  17. Health savings accounts and health reimbursement arrangements: assets, account balances, and rollovers, 2006-2011.

    PubMed

    Fronstin, Paul

    2012-01-01

    ASSET LEVELS GROWING: In 2011, there was $12.4 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 8.4 million accounts, according to data from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey, sponsored by EBRI and Matthew Greenwald & Associates. This is up from 2006, when there were 1.3 million accounts with $873.4 million in assets, and 2010, when 5.4 million accounts held $7.3 billion in assets. AFTER LEVELING OFF, AVERAGE ACCOUNT BALANCES INCREASED: After average account balances leveled off in 2008 and 2009, and fell slightly in 2010, they increased in 2011. In 2006, account balances averaged $696. They increased to $1,320 in 2007, a 90 percent increase. Account balances averaged $1,356 in 2008 and $1,419 in 2009, 3 percent and 5 percent increases, respectively. In 2010, average account balances fell to $1,355, down 4.5 percent from the previous year. In 2011, average account balances increased to $1,470, a 9 percent increase from 2010. TOTAL AND AVERAGE ROLLOVERS INCREASE: After declining to $1,029 in 2010, average rollover amounts increased to $1,208 in 2011. Total assets being rolled over increased as well: $6.7 billion was rolled over in 2011, up from $3.7 billion in 2010. The percentage of individuals without a rollover remained at 13 percent in 2011. HEALTHY BEHAVIOR DOES NOT MEAN HIGHER ACCOUNT BALANCES AND HIGHER ROLLOVERS: Individuals who smoke have more money in their accounts than those who do not smoke. In contrast, obese individuals have less money in their account than the nonobese. There is very little difference in account balances by level of exercise. Very small differences were found in account balances and rollover amounts between individuals who used cost or quality information, compared with those who did not use such information. However, next to no relationship was found between either account balance or rollover amounts and various cost-conscious behaviors. When a difference

  18. Accounting Issues: An Essay Series Part I--Introduction to Accounting Theory and Cash

    ERIC Educational Resources Information Center

    Laux, Judy

    2007-01-01

    Recent accounting scandals challenge academics to refocus the educational process on the theoretical underpinnings of accounting. This is the first in a series of articles designed to facilitate this realignment. Intended as a supplement for the introductory accounting course, the essay series connects each of the primary accounting elements to…

  19. A teleofunctional account of evolutionary mismatch.

    PubMed

    Cofnas, Nathan

    When the environment in which an organism lives deviates in some essential way from that to which it is adapted, this is described as "evolutionary mismatch," or "evolutionary novelty." The notion of mismatch plays an important role, explicitly or implicitly, in evolution-informed cognitive psychology, clinical psychology, and medicine. The evolutionary novelty of our contemporary environment is thought to have significant implications for our health and well-being. However, scientists have generally been working without a clear definition of mismatch. This paper defines mismatch as deviations in the environment that render biological traits unable, or impaired in their ability, to produce their selected effects (i.e., to perform their proper functions in Neander's sense). The machinery developed by Millikan in connection with her account of proper function, and with her related teleosemantic account of representation, is used to identify four major types, and several subtypes, of evolutionary mismatch. While the taxonomy offered here does not in itself resolve any scientific debates, the hope is that it can be used to better formulate empirical hypotheses concerning the effects of mismatch. To illustrate, it is used to show that the controversial hypothesis that general intelligence evolved as an adaptation to handle evolutionary novelty can, contra some critics, be formulated in a conceptually coherent way.

  20. Financial Management Reforms in the Health Sector: A Comparative Study Between Cash-based and Accrual-based Accounting Systems

    PubMed Central

    Abolhallaje, Masoud; Jafari, Mehdi; Seyedin, Hesam; Salehi, Masoud

    2014-01-01

    Background: Financial management and accounting reform in the public sectors was started in 2000. Moving from cash-based to accrual-based is considered as the key component of these reforms and adjustments in the public sector. Performing this reform in the health system is a part of a bigger reform under the new public management. Objectives: The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran. Patients and Methods: This comparative study was conducted in 2013 to compare financial management and movement from cash-based to accrual-based accounting in health sector in the countries such as the United States, Britain, Canada, Australia, New Zealand, and Iran. Library resources and reputable databases such as Medline, Elsevier, Index Copernicus, DOAJ, EBSCO-CINAHL and SID, and Iranmedex were searched. Fish cards were used to collect the data. Data were compared and analyzed using comparative tables. Results: Developed countries have implemented accrual-based accounting and utilized the valid, reliable and practical information in accrual-based reporting in different areas such as price and tariffs setting, operational budgeting, public accounting, performance evaluation and comparison and evidence based decision making. In Iran, however, only a few public organizations such as the municipalities and the universities of medical sciences use accrual-based accounting, but despite what is required by law, the other public organizations do not use accrual-based accounting. Conclusions: There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector. PMID:25763194

  1. Financial Management Reforms in the Health Sector: A Comparative Study Between Cash-based and Accrual-based Accounting Systems.

    PubMed

    Abolhallaje, Masoud; Jafari, Mehdi; Seyedin, Hesam; Salehi, Masoud

    2014-10-01

    Financial management and accounting reform in the public sectors was started in 2000. Moving from cash-based to accrual-based is considered as the key component of these reforms and adjustments in the public sector. Performing this reform in the health system is a part of a bigger reform under the new public management. The current study aimed to analyze the movement from cash-based to accrual-based accounting in the health sector in Iran. This comparative study was conducted in 2013 to compare financial management and movement from cash-based to accrual-based accounting in health sector in the countries such as the United States, Britain, Canada, Australia, New Zealand, and Iran. Library resources and reputable databases such as Medline, Elsevier, Index Copernicus, DOAJ, EBSCO-CINAHL and SID, and Iranmedex were searched. Fish cards were used to collect the data. Data were compared and analyzed using comparative tables. Developed countries have implemented accrual-based accounting and utilized the valid, reliable and practical information in accrual-based reporting in different areas such as price and tariffs setting, operational budgeting, public accounting, performance evaluation and comparison and evidence based decision making. In Iran, however, only a few public organizations such as the municipalities and the universities of medical sciences use accrual-based accounting, but despite what is required by law, the other public organizations do not use accrual-based accounting. There are advantages in applying accrual-based accounting in the public sector which certainly depends on how this system is implemented in the sector.

  2. 12 CFR 513.8 - Removal, suspension, or debarment of independent public accountants and accounting firms...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... independent public accountants and accounting firms performing audit services. 513.8 Section 513.8 Banks and... Removal, suspension, or debarment of independent public accountants and accounting firms performing audit... of independent public accountants and their accounting firms from performing independent audit and...

  3. 12 CFR 513.8 - Removal, suspension, or debarment of independent public accountants and accounting firms...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... public accountants and accounting firms performing audit services. 513.8 Section 513.8 Banks and Banking..., suspension, or debarment of independent public accountants and accounting firms performing audit services. (a... independent public accountants and their accounting firms from performing independent audit and attestation...

  4. 12 CFR 513.8 - Removal, suspension, or debarment of independent public accountants and accounting firms...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... public accountants and accounting firms performing audit services. 513.8 Section 513.8 Banks and Banking..., suspension, or debarment of independent public accountants and accounting firms performing audit services. (a... independent public accountants and their accounting firms from performing independent audit and attestation...

  5. 12 CFR 513.8 - Removal, suspension, or debarment of independent public accountants and accounting firms...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... independent public accountants and accounting firms performing audit services. 513.8 Section 513.8 Banks and... Removal, suspension, or debarment of independent public accountants and accounting firms performing audit... of independent public accountants and their accounting firms from performing independent audit and...

  6. 12 CFR 390.97 - Removal, suspension, or debarment of independent public accountants and accounting firms...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... independent public accountants and accounting firms performing audit services. 390.97 Section 390.97 Banks and... debarment of independent public accountants and accounting firms performing audit services. (a) Scope. This... accountants and their accounting firms from performing independent audit and attestation services required by...

  7. 12 CFR 390.97 - Removal, suspension, or debarment of independent public accountants and accounting firms...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... independent public accountants and accounting firms performing audit services. 390.97 Section 390.97 Banks and... debarment of independent public accountants and accounting firms performing audit services. (a) Scope. This... accountants and their accounting firms from performing independent audit and attestation services required by...

  8. 12 CFR 390.97 - Removal, suspension, or debarment of independent public accountants and accounting firms...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... independent public accountants and accounting firms performing audit services. 390.97 Section 390.97 Banks and... debarment of independent public accountants and accounting firms performing audit services. (a) Scope. This... accountants and their accounting firms from performing independent audit and attestation services required by...

  9. Accounting for metal bioavailability in assessing water quality: A step change?

    PubMed

    Merrington, Graham; Peters, Adam; Schlekat, Christian E

    2016-02-01

    Bioavailability of metals to aquatic organisms can be considered to be a combination of the physicochemical factors governing metal behavior and the specific pathophysiological characteristics of the organism's biological receptor. Effectively this means that a measure of bioavailability will reflect the exposures that organisms in the water column actually "experience". This is important because it has long been established that measures of total metal in waters have limited relevance to potential environmental risk. The concept of accounting for bioavailability in regard to deriving and implementing environmental water quality standards is not new, but the regulatory reality has lagged behind the development of scientific evidence supporting the concept. Practical and technical reasons help to explain this situation. For example, concerns remain from regulators and the regulated that the efforts required to change existing systems of metal environmental protection that have been in place for over 35 yr are so great as not to be commensurate with likely benefits. However, more regulatory jurisdictions are now considering accounting for metal bioavailability in assessments of water quality as a means to support evidence-based decision-making. In the past decade, both the US Environmental Protection Agency and the European Commission have established bioavailability-based standards for metals, including Cu and Ni. These actions have shifted the debate toward identifying harmonized approaches for determining when knowledge is adequate to establish bioavailability-based approaches and how to implement them. © 2016 SETAC.

  10. Solutions for filling gaps in accountable care measure sets.

    PubMed

    Valuck, Tom; Dugan, Donna; Dubois, Robert W; Westrich, Kimberly; Penso, Jerry; McClellan, Mark

    2015-10-01

    A primary objective of accountable care is to support providers in reforming care to improve outcomes and lower costs. Gaps in accountable care measure sets may cause missed opportunities for improvement and missed signals of problems in care. Measures to balance financial incentives may be particularly important for high-cost conditions or specialty treatments. This study explored gaps in measure sets for specific conditions and offers strategies for more comprehensive measurement that do not necessarily require more measures. A descriptive analysis of measure gaps in accountable care programs and proposed solutions for filling the gaps. We analyzed gaps in 2 accountable care organization measure sets for 20 high-priority clinical conditions by comparing the measures in those sets with clinical guidelines and assessing the use of outcome measures. Where we identified gaps, we looked for existing measures to address the gaps. Gaps not addressed by existing measures were considered areas for measure development or measurement strategy refinement. We found measure gaps across all 20 conditions, including those conditions that are commonly addressed in current measure sets. In addition, we found many gaps that could not be filled by existing measures. Results across all 20 conditions informed recommendations for measure set improvement. Addressing all gaps in accountable care measure sets with more of the same types of measures and approaches to measurement would require an impractical number of measures and would miss the opportunity to use better measures and innovative approaches. Strategies for effectively filling measure gaps include using preferred measure types such as cross-cutting, outcome, and patient-reported measures. Program implementers should also apply new approaches to measurement, including layered and modular models.

  11. [Characteristics of organic pollutants in the sediments from a typical electronics industrial zone].

    PubMed

    Liu, Jin; Deng, Dai-Yong; Xu, Mei-Ying; Sun, Guo-Ping

    2013-03-01

    In order to investigate the contamination status of organic pollutants in a river of a typical electrical equipment industrial area, Ronggui, Foshan, the sediments were sampled for the composition, concentration and occurrence analysis of organic pollutants. The polar and non-polar fractionation methods were employed for the fingerprint establishment of organic pollutants. One hundred and seventy-one of organic chemicals including ten categories of alkanes, alkenes, polycyclic aromatic hydrocarbons, benzene, heterocyclic compounds, phthalate esters, aldehydes, ketones, polar compounds, silicon-containing material as well as alkyl esters were examined. The number of different categories of the detected organic pollutants in a descending order was: alkanes > polar compounds > polycyclic aromatic hydrocarbons > aldehydes and ketones > heterocyclic compounds > benzene homologues, phthalate ester > alkyl esters > silicon material > olefins. The abundance of detected organic pollutants in a descending order was: alkanes > polar compounds > alkyl esters > olefins > polycyclic aromatic hydrocarbons > phthalates > silicon material > aldehydes and ketones > heterocyclic compounds > benzene homologues. Among the 51 kinds of alkanes detected, nonadecane accounted for 14.83%, and the persistent organic pollutants accounted for 2.33% of the total organic matter. Compared to similar studies, there were 51 kinds of alkanes and they accounted for 55.5% of the total organic chemicals, showing high diversity and abundance. In addition, some electronics industry-related organic pollutants such as silicone materials were also detected in high frequency.

  12. How Do the Approaches to Accountability Compare for Charities Working in International Development?

    PubMed Central

    Kirsch, David

    2014-01-01

    Approaches to accountability vary between charities working to reduce under-five mortality in underdeveloped countries, and healthcare workers and facilities in Canada. Comparison reveals key differences, similarities and trade-offs. For example, while health professionals are governed by legislation and healthcare facilities have a de facto obligation to be accredited, charities and other international organizations are not subject to mandatory international laws or guidelines or to de facto international standards. Charities have policy goals similar to those found in the Canadian substudies, including access, quality, cost control, cost-effectiveness and customer satisfaction. However, the relative absence of external policy tools means that these goals may not be realized. Accountability can be beneficial, but too much or the wrong kind of accountability can divert resources and diminish returns. PMID:25305397

  13. How do the approaches to accountability compare for charities working in international development?

    PubMed

    Kirsch, David

    2014-09-01

    Approaches to accountability vary between charities working to reduce under-five mortality in underdeveloped countries, and healthcare workers and facilities in Canada. Comparison reveals key differences, similarities and trade-offs. For example, while health professionals are governed by legislation and healthcare facilities have a de facto obligation to be accredited, charities and other international organizations are not subject to mandatory international laws or guidelines or to de facto international standards. Charities have policy goals similar to those found in the Canadian substudies, including access, quality, cost control, cost-effectiveness and customer satisfaction. However, the relative absence of external policy tools means that these goals may not be realized. Accountability can be beneficial, but too much or the wrong kind of accountability can divert resources and diminish returns. Copyright © 2014 Longwoods Publishing.

  14. What ever happened to accountability?

    PubMed

    Ricks, Thomas E

    2012-10-01

    When leaders don't fire underperforming executives, they send a bad message to the whole organization. A case in point is the U.S. Army. "To study the change in the army across the two decades between World War II and Vietnam," Ricks writes, "is to learn how a culture of high standards and accountability can deteriorate." In this essay, adapted from his new book, The Generals: American Military Command from World War II to Today, Ricks illuminates the contrast between General George C. Marshall, an unlikely figure of quiet resolve who became a classic transformational Leader, and the disastrous generals of the Vietnam era. In Vietnam, he writes, the honesty and accountability of Marshall's system were replaced by deceit and command indiscipline. If inadequate leaders are allowed to remain in command of an enterprise, their superiors must look for other ways to accomplish its goals. In Vietnam commanders turned to micromanagement, hovering overhead in helicopters to direct (and interfere with) squad leaders and platoon leaders on the ground. This both undercut combat effectiveness and denied small-unit leaders the opportunity to grow by making decisions under extreme pressure. In Iraq and Afghanistan, Ricks writes, though U.S. troops fought their battles magnificently, their generals often seemed ill equipped for the tasks at hand-especially the difficult but essential job of turning victories on the ground into strategic progress. This brief but powerful history of the army since World War II holds stark lessons for business leaders.

  15. 32 CFR 352a.3 - Organization and management.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 2 2010-07-01 2010-07-01 false Organization and management. 352a.3 Section 352a.3 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) ORGANIZATIONAL CHARTERS DEFENSE FINANCE AND ACCOUNTING SERVICE (DFAS) § 352a.3 Organization and management. (a...

  16. Accounting and accountability: observations on the AHERF settlements.

    PubMed

    Maco, P S; Weinstein, S J

    2000-10-01

    Recent enforcement proceedings involving health care and accounting--relating primarily to the Allegheny Health, Education and Research Foundation (AHERF)--have sparked renewed interest in the activities of the U.S. Securities and Exchange Commission in the municipal securities market. Officials and accountants who are working for public-sector issuers in the healthcare industry have responsibilities under the Federal securities laws. Other issues of relevance include disclosure in the secondary market as well as upon initial issuance, and the significance of antifraud actions in other areas.

  17. Automating Base Fuels Accounting.

    DTIC Science & Technology

    1986-03-01

    base fuels accounting system as a means to decrease operating cost and increase capability. Author reviews the present accounting system, then proposes...g .:..: . . ; ,N :’- .’ :+-" : :*- . ’++ : :,:- :1:.-’ ."-..: :.:.:’’ AIR WAR COLLEGE No. AU-AWC86-0 9 0 00a AUTOMATING BASE FUELS ACCOUNTING ... ACCOUNTING by Victor E. Hardin Lieutenant Colonel, USAF A RESEARCH REPORT SUBMITTED TO THE FACULTY IN FULFILLMENT OF THE RESEARCH REQUI REMENT

  18. Health savings accounts and health reimbursement arrangements: assets, account balances, and rollovers, 2006-2010.

    PubMed

    Fronstin, Paul

    2011-01-01

    ASSET LEVELS GROWING: In 2010, there was $7.7 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 5.7 million accounts. This is up from 2006, when there were 1.2 million accounts with $835.4 million in assets, and 2009, when 5 million accounts held $7.1 billion in assets. AFTER LEVELING OFF, AVERAGE ACCOUNT BALANCE DROPS SLIGHTLY: Increases in average account balances leveled off in 2008 and 2009, and fell slightly in 2010. In 2006, account balances averaged $696. They increased to $1,320 in 2007, a 90 percent increase. Account balances averaged $1,356 in 2008 and $1,419 in 2009, 3 percent and 5 percent increases, respectively. In 2010, average account balances fell to $1,355, down 4.5 percent from the previous year. AVERAGE ROLLOVER DECLINES, WHILE TOTAL ROLLOVERS INCREASE: Despite a decline in the average rollover amount in 2010, total assets being rolled over have been increasing. $4.2 billion was rolled over in 2010, up from $4 billion in 2009. The average rollover increased from $592 in 2006 to $1,295 in 2009, and fell to $1,029 in 2010. The percentage of individuals without a rollover decreased from 23 percent in 2006 to 10 percent in 2009 and increased slightly to 13 percent in 2010. HEALTHY BEHAVIOR MEANS HIGHER ACCOUNT BALANCES AND HIGHER ROLLOVERS: Individuals who exercised, those who did not smoke, and those who were not obese had higher account balances and higher rollovers than those with less healthy behaviors. It was also found that individuals who used cost or quality information had higher account balances and higher rollovers compared with those who did not use such information. However, no relationship was found between either account balance or rollover amounts and various cost-conscious behaviors such as checking pricing before getting services or asking for generic drugs instead of brand names, among other things. DIFFERENCES IN ACCOUNT BALANCES: Men have higher account balances than women

  19. A Direct Experience in a New Accountable Care Organization: Results, Challenges, and the Role of the Neurosurgeon.

    PubMed

    Kim, Dong H; Lloyd, Christopher; Fernandez, Douglas K; Spielman, Amanda; Bradshaw, David

    2017-04-01

    The passage of the Affordable Care Act saw the creation of Accountable Care Organizations (ACOs), a new approach to healthcare delivery moving from fee-for-service toward population health. This paper presents a case study of the Memorial Hermann ACO (MHACO), launched in response to the Medicare Shared Savings Program, with goals to align physician and hospital incentives, practice evidence-based medicine, develop care coordination, and increase efficiency. Building blocks included an affiliated primary care network, a clinical integration program (involving shared electronic medical record platforms and quality data reporting), and significant investments in information technology. Presented is the approach taken to form MHACO; the management structure, technology developed, and a 2-year experience. Incorporated in July 2012, the MHACO involved 22 000 Medicare patients. In 2015, Centers for Medicare and Medicaid Services released data showing a composite quality score between 80 and 85 (from a maximum 100) and nearly $53 million in total savings (or 11% of expected expenditure), making MHACO one of the most successful nationally.1 In fewer than 5 years, almost 500 ACOs have developed, and by some estimates, a quarter of Medicare patients are currently enrolled in an ACO. Although ACOs to date have focused on primary care, the future will increasingly involve specialists. At Memorial Hermann, neurosurgeons took an early role in forming collaborative partnerships with the hospital, and started programs that served as precursors to the ACO model. This paper ends with an overview of ACO development, likely changes going forward, and a discussion of the role of specialists in general, and of neurosurgeons in particular. Copyright © 2016 by the Congress of Neurological Surgeons.

  20. Challenges of stimulating a market for social innovation - provision of a national health account.

    PubMed

    Wass, Sofie; Vimarlund, Vivian

    2015-01-01

    Innovation in healthcare can be associated with social innovation and the mission to contribute to a shared value that benefits not only individuals or organizations but the society as a whole. In this paper, we present the prerequisites of stimulating a market for social innovations by studying the introduction of a national health account. The results show that there is a need to clarify if a national health account should be viewed as a public good or not, to clarify the financial responsibilities of different actors, to establish clear guidelines and to develop regulations concerning price, quality and certification of actors. The ambition to stimulate the market through a national health account is a promising start. However, the challenges have to be confronted in order for public and private actors to collaborate and build a market for social innovations such as a national health account.

  1. Transparency and accountability in mass media campaigns about organ donation: a response to Morgan and Feeley.

    PubMed

    Rady, Mohamed Y; McGregor, Joan L; Verheijde, Joseph L

    2013-11-01

    We respond to Morgan and Feeley's critique on our article "Mass Media in Organ Donation: Managing Conflicting Messages and Interests." We noted that Morgan and Feeley agree with the position that the primary aims of media campaigns are: "to educate the general public about organ donation process" and "help individuals make informed decisions" about organ donation. For those reasons, the educational messages in media campaigns should not be restricted to "information from pilot work or focus groups" but should include evidence-based facts resulting from a comprehensive literature research. We consider the controversial aspects about organ donation to be relevant, if not necessary, educational materials that must be disclosed in media campaigns to comply with the legal and moral requirements of informed consent. With that perspective in mind, we address the validity of Morgan and Feeley's claim that media campaigns have no need for informing the public about the controversial nature of death determination in organ donation. Scientific evidence has proven that the criteria for death determination are inconsistent with the Uniform Determination of Death Act and therefore potentially harmful to donors. The decision by campaign designers to use the statutory definition of death without disclosing the current controversies surrounding that definition does not contribute to improved informed decision making. We argue that if Morgan and Feeley accept the important role of media campaigns to enhance informed decision making, then critical controversies should be disclosed. In support of that premise, we will outline: (1) the wide-spread scientific challenges to brain death as a concept of death; (2) the influence of the donor registry and team-huddling on the medical care of potential donors; (3) the use of authorization rather than informed consent for donor registration; (4) the contemporary religious controversy; and (5) the effects of training desk clerks as organ

  2. Independent practice associations and physician-hospital organizations can improve care management for smaller practices.

    PubMed

    Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M

    2013-08-01

    Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.

  3. The Accounting Capstone Problem

    ERIC Educational Resources Information Center

    Elrod, Henry; Norris, J. T.

    2012-01-01

    Capstone courses in accounting programs bring students experiences integrating across the curriculum (University of Washington, 2005) and offer unique (Sanyal, 2003) and transformative experiences (Sill, Harward, & Cooper, 2009). Students take many accounting courses without preparing complete sets of financial statements. Accountants not only…

  4. Composting and compost utilization: accounting of greenhouse gases and global warming contributions.

    PubMed

    Boldrin, Alessio; Andersen, Jacob K; Møller, Jacob; Christensen, Thomas H; Favoino, Enzo

    2009-11-01

    Greenhouse gas (GHG) emissions related to composting of organic waste and the use of compost were assessed from a waste management perspective. The GHG accounting for composting includes use of electricity and fuels, emissions of methane and nitrous oxide from the composting process, and savings obtained by the use of the compost. The GHG account depends on waste type and composition (kitchen organics, garden waste), technology type (open systems, closed systems, home composting), the efficiency of off-gas cleaning at enclosed composting systems, and the use of the compost. The latter is an important issue and is related to the long-term binding of carbon in the soil, to related effects in terms of soil improvement and to what the compost substitutes; this could be fertilizer and peat for soil improvement or for growth media production. The overall global warming factor (GWF) for composting therefore varies between significant savings (-900 kg CO(2)-equivalents tonne(-1) wet waste (ww)) and a net load (300 kg CO(2)-equivalents tonne( -1) ww). The major savings are obtained by use of compost as a substitute for peat in the production of growth media. However, it may be difficult for a specific composting plant to document how the compost is used and what it actually substitutes for. Two cases representing various technologies were assessed showing how GHG accounting can be done when specific information and data are available.

  5. Measuring and Communicating the Value Created by an Organization

    ERIC Educational Resources Information Center

    Sherman, W. Richard

    2010-01-01

    This paper offers a different perspective in measuring the value created by an organization. It does so in the context of an undergraduate course in managerial accounting. In order to break down the functional silo approach to problem solving that has become the model of traditional business education, applications of shadow accounting, the…

  6. Iowa Community Colleges Accounting Manual.

    ERIC Educational Resources Information Center

    Iowa State Dept. of Education, Des Moines. Div. of Community Colleges and Workforce Preparation.

    This document describes account classifications and definitions for the accounting system of the Iowa community colleges. In view of the objectives of the accounting system, it is necessary to segregate the assets of the community college according to its source and intended use. Additionally, the accounting system should provide for accounting by…

  7. Organism and artifact: Proper functions in Paley organisms.

    PubMed

    Holm, Sune

    2013-12-01

    In this paper I assess the explanatory powers of theories of function in the context of products that may result from synthetic biology. The aim is not to develop a new theory of functions, but to assess existing theories of function in relation to a new kind of biological and artifactual entity that might be produced in the not-too-distant future by means of synthetic biology. The paper thus investigates how to conceive of the functional nature of living systems that are not the result of evolution by natural selection, or instantly generated by cosmic coincidence, but which are products of intelligent design. The paper argues that the aetiological theory of proper functions in organisms and artifacts is inadequate as an account of proper functions in such 'Paley organisms' and defends an alternative organisational approach. The paper ends by considering the implications of the discussion of biological function for questions about the interests and moral status of non-sentient organisms. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. 17 CFR 256.301 - Organization.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Organization. 256.301 Section 256.301 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) UNIFORM... service company such as stock, minute books and corporate seal. Note: This account shall not include any...

  9. 17 CFR 256.301 - Organization.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 17 Commodity and Securities Exchanges 3 2011-04-01 2011-04-01 false Organization. 256.301 Section 256.301 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) UNIFORM... service company such as stock, minute books and corporate seal. Note: This account shall not include any...

  10. "Accounting Education at a Crossroad in 2010" and "Challenges Facing Accounting Education in Australia"

    ERIC Educational Resources Information Center

    de Lange, Paul; Watty, Kim

    2011-01-01

    Of the various reports released in 2010, two purport to examine the state of accounting education in Australia. These are "Accounting Education at a Crossroad in 2010" and "Challenges Facing Accounting Education in Australia". Both were released as collaborations of the leading academic organisation, the Accounting and Finance…

  11. 25 CFR 900.58 - Do the same accountability and control procedures described above apply to Federal property?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management System Standards § 900.58 Do the same accountability and...

  12. 25 CFR 900.58 - Do the same accountability and control procedures described above apply to Federal property?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management System Standards § 900.58 Do the same accountability and...

  13. 25 CFR 900.58 - Do the same accountability and control procedures described above apply to Federal property?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management System Standards § 900.58 Do the same accountability and...

  14. 25 CFR 900.58 - Do the same accountability and control procedures described above apply to Federal property?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management System Standards § 900.58 Do the same accountability and...

  15. 25 CFR 900.58 - Do the same accountability and control procedures described above apply to Federal property?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... UNDER THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization Management Systems Property Management System Standards § 900.58 Do the same accountability and...

  16. Organic synthesis in a changing world.

    PubMed

    Ley, Steven V; Baxendale, Ian R

    2002-01-01

    This article is based on a lecture presented to the Chemical Society of Japan at Wasada University on March 27, 2002, by Professor Steven V. Ley. The lecture, "Organic Synthesis in a Changing World," was a comprehensive account of the ongoing research efforts of professor Ley's group in the development and application of solid-supported reagents and scavengers for use in organic synthesis. Copyright 2002 The Japan Chemical Journal Forum and Wiley Periodicals, Inc.

  17. Accountable disease management of spine pain.

    PubMed

    Smith, Matthew J

    2011-09-01

    The health care landscape has changed with new legislation addressing the unsustainable rise in costs in the US system. Low-value service lines caring for expensive chronic conditions have been targeted for reform; for better or worse, the treatment of spine pain has been recognized as a representative example. Examining the Patient Protection and Affordable Care Act and existing pilot studies can offer a preview of how chronic care of spine pain will be sustained. Accountable care in an organization capable of collecting, analyzing, and reporting clinical data and operational compliance is forthcoming. Interdisciplinary spine pain centers integrating surgical and medical management, behavioral medicine, physical reconditioning, and societal reintegration represent the model of high-value care for patients with chronic spine pain. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Are ACOs ready to be accountable for medication use?

    PubMed

    Dubois, Robert W; Feldman, Marv; Lustig, Adam; Kotzbauer, Greg; Penso, Jerry; Pope, Scott D; Westrich, Kimberly D

    2014-01-01

    Accountable care organizations (ACOs) have the potential to lower costs and improve quality through incentives and coordinated care. However, the design brings with it many new challenges. One such challenge is the optimal use of pharmaceuticals. Most ACOs have not yet focused on this integral facet of care, even though medications are a critical component to achieving the lower costs and improved quality that are anticipated with this new model. To evaluate whether ACOs are prepared to maximize the value of medications for achieving quality benchmarks and cost offsets. During the fall of 2012, an electronic readiness self-assessment was developed using a portion of the questions and question methodology from the National Survey of Accountable Care Organizations, along with original questions developed by the authors. The assessment was tested and subsequently revised based on feedback from pilot testing with 5 ACO representatives. The revised assessment was distributed via e-mail to a convenience sample (n=175) of ACO members of the American Medical Group Association, Brookings-Dartmouth ACO Learning Network, and Premier Healthcare Alliance. The self-assessment was completed by 46 ACO representatives (26% response rate). ACOs reported high readiness to manage medications in a few areas, such as transmitting prescriptions electronically (70%), being able to integrate medical and pharmacy data into a single database (54%), and having a formulary in place that encourages generic use when appropriate (50%). However, many areas have substantial room for improvement with few ACOs reporting high readiness. Some notable areas include being able to quantify the cost offsets and hence demonstrate the value of appropriate medication use (7%), notifying a physician when a prescription has been filled (9%), having protocols in place to avoid medication duplication and polypharmacy (17%), and having quality metrics in place for a broad diversity of conditions (22%). Developing

  19. 31 CFR 597.203 - Holding of funds in interest-bearing accounts; investment and reinvestment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Holding of funds in interest-bearing accounts; investment and reinvestment. 597.203 Section 597.203 Money and Finance: Treasury Regulations... FOREIGN TERRORIST ORGANIZATIONS SANCTIONS REGULATIONS Prohibitions § 597.203 Holding of funds in interest...

  20. The influence of organic substances type on the properties of mineral-organic fertilizers

    NASA Astrophysics Data System (ADS)

    Huculak-Mä Czka, Marta; Hoffmann, Krystyna; Hoffmann, Józef

    2010-05-01

    which are used for suspension fertilizers manufacturing meet these requirements as well. In the presented studies lignite coal was applied as a component of mineral-organic preparations. The advantages of lignite coal are positive influence on the soil heat balance and reduction of the temperature fluctuations influence as well as humic acids contents that are extracted during its decomposition improving the soil structure and enrichment with humus substances. The lignite coal used in examinations contained 50 - 60 wt. % of Corg, about 45 cmol/kg Ca, 18.5 cmol/kg Mg and P, K, N in the ppm amount. Unfortunately the fertilizer components included in the lignite coal are rather unavailable for plants. It seems, that progress of lignite coal mineralization and humification can be expressed in the increasing content of humus substances. Humus acids are of great importance for plants on account of their solubility. During examination on the selection of fertilizer components a Corg content was analyzed as a parameter determining the quality of mineral-organic preparations. As the analytical technique for Corg determination particularly a Tiurin method was applied. Apart from lignite coal and peat as the source of organic substance the poultry droppings and compost on their basis were analyzed. Poultry droppings depending on bird species as well as feeding and breeding method are characterized by variable composition. A high pH values and a large content of nitrogen are their distinctive features, sometimes too high on account of plant nutritional requirements, and toxic as well as limiting cropping. Taking environmental protection requirements into consideration as well as on account of proper plants nutrition an appropriate preparation of mineral-organic fertilizer is recommended what can be obtained by applying lignite coal and poultry droppings as components of fertilizer using appropriate proportion. Adapting composted poultry droppings is more beneficial, but requires

  1. Accounting & Computing Curriculum Guide.

    ERIC Educational Resources Information Center

    Avani, Nathan T.; And Others

    This curriculum guide consists of materials for use in teaching a competency-based accounting and computing course that is designed to prepare students for employability in the following occupational areas: inventory control clerk, invoice clerk, payroll clerk, traffic clerk, general ledger bookkeeper, accounting clerk, account information clerk,…

  2. Clinical trial registration and reporting: a survey of academic organizations in the United States.

    PubMed

    Mayo-Wilson, Evan; Heyward, James; Keyes, Anthony; Reynolds, Jesse; White, Sarah; Atri, Nidhi; Alexander, G Caleb; Omar, Audrey; Ford, Daniel E

    2018-05-02

    Many clinical trials conducted by academic organizations are not published, or are not published completely. Following the US Food and Drug Administration Amendments Act of 2007, "The Final Rule" (compliance date April 18, 2017) and a National Institutes of Health policy clarified and expanded trial registration and results reporting requirements. We sought to identify policies, procedures, and resources to support trial registration and reporting at academic organizations. We conducted an online survey from November 21, 2016 to March 1, 2017, before organizations were expected to comply with The Final Rule. We included active Protocol Registration and Results System (PRS) accounts classified by ClinicalTrials.gov as a "University/Organization" in the USA. PRS administrators manage information on ClinicalTrials.gov. We invited one PRS administrator to complete the survey for each organization account, which was the unit of analysis. Eligible organization accounts (N = 783) included 47,701 records (e.g., studies) in August 2016. Participating organizations (366/783; 47%) included 40,351/47,701 (85%) records. Compared with other organizations, Clinical and Translational Science Award (CTSA) holders, cancer centers, and large organizations were more likely to participate. A minority of accounts have a registration (156/366; 43%) or results reporting policy (129/366; 35%). Of those with policies, 15/156 (11%) and 49/156 (35%) reported that trials must be registered before institutional review board approval is granted or before beginning enrollment, respectively. Few organizations use computer software to monitor compliance (68/366; 19%). One organization had penalized an investigator for non-compliance. Among the 287/366 (78%) accounts reporting that they allocate staff to fulfill ClinicalTrials.gov registration and reporting requirements, the median number of full-time equivalent staff is 0.08 (interquartile range = 0.02-0.25). Because of non-response and

  3. Accountable care organizations: benefits and barriers as perceived by Rural Health Clinic management.

    PubMed

    Ortiz, Judith; Bushy, Angeline; Zhou, Yue; Zhang, Hong

    2013-01-01

    Rural Health Clinics (RHCs) have served the primary healthcare needs of the medically underserved in US rural areas for more than 30 years. As a new model of healthcare delivery, the Accountable Care Organization (ACO) offers potential opportunities for addressing the healthcare needs of rural populations, yet little is known about how the ACO model will meet the needs of RHCs. This article reports on the results of a survey, focus groups, and phone interviews with RHC management personnel on the subject of benefits of and barriers to RHC participation in ACOs. Survey research, focus groups, and phone interviews were used to gather and analyze the opinions of RHCs' management about the benefits of and barriers to ACO participation. The study population consisted of all 2011 RHCs in Region 4 (Southeastern USA; as designated by the Department of Health and Human Services). California RHCs were used for comparison. Themes and concepts for the survey questionnaire were developed from recent literature. The survey data were analyzed in two stages: (1) analyses of the characteristics of the RHCs and their responses; and (2) bivariate analyses of several relationships using a variety of statistics including analysis of variance, Pearson's χ² and likelihood χ². Relationships were examined between the RHCs' willingness to join ACOs and the respondent clinic's classification (as provider-based or independent). In addition, willingness to join ACOs among Region 4 RHCs was compared with those in California. Finally, in order to gain a broader understanding of the results of the survey, focus groups and phone interviews were conducted with RHC personnel. It was found that the ACO model is generally unfamiliar to RHCs. Approximately 48% of the survey respondents reported having little knowledge of ACOs; the focus group participants and interviewees likewise reported a lack of knowledge. Among respondents who were knowledgeable about ACOs, the most frequently citied

  4. 48 CFR 9904.411 - Cost accounting standard-accounting for acquisition costs of material.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard-accounting for acquisition costs of material. 9904.411 Section 9904.411 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND...

  5. Accounting and Accountability for Distributed and Grid Systems

    NASA Technical Reports Server (NTRS)

    Thigpen, William; McGinnis, Laura F.; Hacker, Thomas J.

    2001-01-01

    While the advent of distributed and grid computing systems will open new opportunities for scientific exploration, the reality of such implementations could prove to be a system administrator's nightmare. A lot of effort is being spent on identifying and resolving the obvious problems of security, scheduling, authentication and authorization. Lurking in the background, though, are the largely unaddressed issues of accountability and usage accounting: (1) mapping resource usage to resource users; (2) defining usage economies or methods for resource exchange; (3) describing implementation standards that minimize and compartmentalize the tasks required for a site to participate in a grid.

  6. Managerial Accounting. Study Guide.

    ERIC Educational Resources Information Center

    Plachta, Leonard E.

    This self-instructional study guide is part of the materials for a college-level programmed course in managerial accounting. The study guide is intended for use by students in conjuction with a separate textbook, Horngren's "Accounting for Management Control: An Introduction," and a workbook, Curry's "Student Guide to Accounting for Management…

  7. Intelligent Accountability in Education

    ERIC Educational Resources Information Center

    O'Neill, Onora

    2013-01-01

    Systems of accountability are "second order" ways of using evidence of the standard to which "first order" tasks are carried out for a great variety of purposes. However, more accountability is not always better, and processes of holding to account can impose high costs without securing substantial benefits. At their worst,…

  8. A Neurocomputational Account of Taxonomic Responding and Fast Mapping in Early Word Learning

    ERIC Educational Resources Information Center

    Mayor, Julien; Plunkett, Kim

    2010-01-01

    We present a neurocomputational model with self-organizing maps that accounts for the emergence of taxonomic responding and fast mapping in early word learning, as well as a rapid increase in the rate of acquisition of words observed in late infancy. The quality and efficiency of generalization of word-object associations is directly related to…

  9. Ranking Accounting Authors and Departments in Accounting Education: Different Methodologies--Significantly Different Results

    ERIC Educational Resources Information Center

    Bernardi, Richard A.; Zamojcin, Kimberly A.; Delande, Taylor L.

    2016-01-01

    This research tests whether Holderness Jr., D. K., Myers, N., Summers, S. L., & Wood, D. A. [(2014). "Accounting education research: Ranking institutions and individual scholars." "Issues in Accounting Education," 29(1), 87-115] accounting-education rankings are sensitive to a change in the set of journals used. It provides…

  10. Accounting Academics' Perceptions of the Effect of Accreditation on UK Accounting Degrees

    ERIC Educational Resources Information Center

    Ellington, Peter; Williams, Amanda

    2017-01-01

    Students graduating from undergraduate accounting degree programmes in the UK are eligible for and attracted by accreditation available from professional accountancy body (PAB) examinations. The study reviews factual information available from PAB websites to confirm that virtually all accounting degrees in the UK have accreditation, and many are…

  11. Deterrents to Accountability.

    ERIC Educational Resources Information Center

    Hencley, Stephen P.

    This speech assesses potential deterrents to the implementation of accountability in education. The author divides these deterrents into (1) philosophical-ideological; humanist-behaviorist conflicts, individuality versus "techno-urban fascism," and accountability systems tied to the achievement of cognitive objectives at the lower end of Bloom's…

  12. Revamping High School Accounting Courses.

    ERIC Educational Resources Information Center

    Bittner, Joseph

    2002-01-01

    Provides ideas for updating accounting courses: convert to semester length; focus on financial reporting/analysis, financial statements, the accounting cycle; turn textbook exercises into practice sets for the accounting cycle; teach about corporate accounting; and address individual line items on financial statements. (SK)

  13. Accounting Department Chairpersons' Perceptions of Business School Performance Using a Market Orientation Model

    ERIC Educational Resources Information Center

    Webster, Robert L.; Hammond, Kevin L.; Rothwell, James C.

    2013-01-01

    This manuscript is part of a stream of continuing research examining market orientation within higher education and its potential impact on organizational performance. The organizations researched are business schools and the data collected came from chairpersons of accounting departments of AACSB member business schools. We use a reworded Narver…

  14. Specificity of different organic nitrates to elicit NO formation in rabbit vascular tissues and organs in vivo.

    PubMed Central

    Mülsch, A.; Bara, A.; Mordvintcev, P.; Vanin, A.; Busse, R.

    1995-01-01

    liver enhanced NO formation in a NADPH-dependent fashion from NTG, but not from the other nitrates, as assessed by activation of purified soluble guanylyl cyclase. 6. We conclude that the vessel selective action of different organic nitrates in vivo reflects differences in vascular NO formation. Thus, efficient preload reduction by classical organic nitrates can be accounted for by higher NO formation in venous capacitance as compared to arterial conductance and resistance vessels. In contrast, NO is released from cysteine-containing nitrates (SPMs) to a similar extent in arteries and veins, presumably independently of an organic nitrate-specific biotransformation. Limited tissue bioavailability of NTG and ISDN might account for low NO formation in the aorta, while true differences in biotransformation seem to account for differences in NO formation in the other vascular tissues. PMID:8590999

  15. Public Accountancy Handbook.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Office of the Professions.

    A reference guide to laws, rules, and regulations that govern public accountancy practice in New York State is presented. In addition to identifying licensing requirements/procedures for certified public accountants, general provisions of Title VIII of the Education Law are covered, along with state management, professional misconduct, and…

  16. The potential of legislation on organ donation to increase the supply of donor organs.

    PubMed

    Coppen, Remco; Friele, Roland D; van der Zee, Jouke; Gevers, Sjef K

    2010-12-01

    The aim of this paper is to assess the possibilities to adapt the 1998 Dutch Organ Donation Act, taking account of fundamental principles such as the right to physical integrity, equitable access to and equal availability of care, and the non-commerciality principle, with a view to increasing the organ supply. In 2008 the Dutch Taskforce on Organ Donation presented several proposals to amend the Act and to increase the supply of organs. This paper describes the proposals to amend the Act and evaluates them by assessing their intrinsic adherence to basic principles and the available evidence that these proposals will indeed increase the organ supply. Several proposals could constitute an infringement of fundamental principles of the Act. Moreover, evidence for their impact on the organ supply is lacking. Changing the consent system is possible, as this would not incur legal objections. There are diverging views regarding the impact of consent systems on the organ supply. The scope for changing the Act and its impact on organ procurement is at best limited. Relying on legislation alone will possibly not bring much relief, whereas additional policy measures may be more successful. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  17. Precambrian organic geochemistry - Preservation of the record

    NASA Technical Reports Server (NTRS)

    Hayes, J. M.; Wedeking, K. W.; Kaplan, I. R.

    1983-01-01

    A review of earlier studies is presented, and new results in Precambrian organic geochemistry are discussed. It is pointed out that two lines of evidence can be developed. One is based on structural organic chemistry, while the other is based on isotopic analyses. In the present investigation, the results of both structural and isotopic investigations of Precambrian organic matter are discussed. Processes and products related to organic geochemistry are examined, taking into account the carbon cycle, an approximate view of the principal pathways of carbon cycling associated with organic matter in the present global ecosystem, processes affecting sedimentary organic matter, and distribution and types of organic matter. Attention is given to chemical fossils in Precambrian sediments, kerogen analyses, the determination of the structural characteristics of kerogen, and data concerning the preservation of the Precambrian organic geochemical record.

  18. Ethical Practice Under Accountable Care

    PubMed Central

    Bhandary, Asha; Rizzo, Matthew

    2017-01-01

    Accountable Care Organizations (ACOs) are a key mechanism of the Patient Protection and Affordable Care Act (PPACA). ACOs will influence incentives for providers, who must understand these changes to make well-considered treatment decisions. Our paper defines an ethical framework for physician decisions and action within ACOs. Emerging ethical pressures providers will face as members of an ACO were classified under major headings representing three of the four principles of bioethics: autonomy, beneficence, and justice (no novel conflicts with non-maleficence were identified). Conflicts include a bias against transient populations, a motive to undertreat conditions lacking performance measures, and the mandate to improve population health incentivizing life intrusions. After introducing and explaining each conflict, recommendations are offered for how providers ought to precede in the face of novel ethical choices. Our description of novel ethical choices will help providers know what to expect and our recommendations can guide providers in choosing well. PMID:26002491

  19. Organosulfates and organic acids in Arctic aerosols: speciation, annual variation and concentration levels

    NASA Astrophysics Data System (ADS)

    Hansen, A. M. K.; Kristensen, K.; Nguyen, Q. T.; Zare, A.; Cozzi, F.; Nøjgaard, J. K.; Skov, H.; Brandt, J.; Christensen, J. H.; Ström, J.; Tunved, P.; Krejci, R.; Glasius, M.

    2014-02-01

    Sources, composition and occurrence of secondary organic aerosols (SOA) in the Arctic were investigated at Zeppelin Mountain, Svalbard, and Station Nord, northeast Greenland, during the full annual cycle of 2008 and 2010 respectively. We focused on the speciation of three types of SOA tracers: organic acids, organosulfates and nitrooxy organosulfates from both anthropogenic and biogenic precursors, here presenting organosulfate concentrations and compositions during a full annual cycle and chemical speciation of organosulfates in Arctic aerosols for the first time. Aerosol samples were analysed using High Performance Liquid Chromatography coupled to a quadrupole Time-of-Flight mass spectrometer (HPLC-q-TOF-MS). A total of 11 organic acids (terpenylic acid, benzoic acid, phthalic acid, pinic acid, suberic acid, azelaic acid, adipic acid, pimelic acid, pinonic acid, diaterpenylic acid acetate (DTAA) and 3-methyl-1,2,3-butanetricarboxylic acid (MBTCA)), 12 organosulfates and one nitrooxy organosulfate were identified at the two sites. Six out of the 12 organosulfates are reported for the first time. Concentrations of organosulfates follow a distinct annual pattern at Station Nord, where high concentration were observed in late winter and early spring, with a mean total concentration of 47 (±14) ng m-3, accounting for 7 (±2)% of total organic matter, contrary to a considerably lower organosulfate mean concentration of 2 (±3) ng m-3 (accounting for 1 (±1)% of total organic matter) observed during the rest of the year. The organic acids followed the same temporal trend as the organosulfates at Station Nord; however the variations in organic acid concentrations were less pronounced, with a total mean organic acid concentration of 11.5 (±4) ng m-3 (accounting for 1.7 (±0.6)% of total organic matter) in late winter and early spring, and 2.2 (±1) ng m-3 (accounting for 0.9 (±0.4)% of total organic matter) during the rest of the year. At Zeppelin Mountain

  20. Origins and Elaboration of the National Health Accounts, 1926-2006

    PubMed Central

    Fetter, Bruce

    2006-01-01

    The National Health Statistics Group (NHSG) has managed to keep the national health accounts (NHA) apolitical and highly respected. NHSG strategies have included the careful acquisition and presentation of statistics relating to health costs and payers; the use of scholarly journals to disseminate ideas to other government offices and, beyond them, to industry, labor, the professions, and universities; and the promotion of cooperation with related U.S., statistical agencies, provider groups, contractors, and international organizations. Responding to an increasingly complex system of third-party payers in the U.S. health system and controversies over methods, the NHA has continually evolved to meet the demands of health care decisionmakers. Historically, these dialogues have forced health accountants to refine their methods to ensure that their portrayal of spending and financing trends presents information that can inform the decisionmaking process in a non-partisan way. PMID:17290668

  1. 31 CFR 561.504 - Transactions related to closing a correspondent account or payable-through account.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... accounts or payable-through accounts for the foreign financial institution are authorized to: (1) Process... TREASURY IRANIAN FINANCIAL SANCTIONS REGULATIONS Licenses, Authorizations, and Statements of Licensing... opening or maintaining of a correspondent account or a payable-through account for a foreign financial...

  2. 75 FR 81684 - Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-28

    ... Accounting Oversight Board Budget and Annual Accounting Support Fee for Calendar Year 2011 The Sarbanes-Oxley Act of 2002, as amended (the ``Sarbanes-Oxley Act''), established the Public Company Accounting... through registration of public accounting firms and standard setting, inspection, and disciplinary...

  3. 78 FR 11915 - Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-20

    ... Accounting Oversight Board Budget and Annual Accounting Support Fee for Calendar Year 2013 The Sarbanes-Oxley Act of 2002, as amended (the ``Sarbanes-Oxley Act''),\\1\\ established the Public Company Accounting... through registration of public accounting firms and standard setting, inspection, and disciplinary...

  4. 76 FR 49365 - Cost Accounting Standards: Elimination of the Exemption From Cost Accounting Standards for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-10

    ... Accounting Standards: Elimination of the Exemption From Cost Accounting Standards for Contracts and...: Office of Management and Budget (OMB), Office of Federal Procurement Policy (OFPP), Cost Accounting... Accounting Standards (CAS) Board, is publishing a final rule to eliminate the exemption from regulations...

  5. 77 FR 2576 - Order Approving Public Company Accounting Oversight Board Budget and Annual Accounting Support...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-18

    ... Accounting Oversight Board Budget and Annual Accounting Support Fee for Calendar Year 2012 The Sarbanes-Oxley Act of 2002, as amended (the ``Sarbanes-Oxley Act''),\\1\\ established the Public Company Accounting... through registration of public accounting firms and standard setting, inspection, and disciplinary...

  6. Accountability and the New Essentials.

    ERIC Educational Resources Information Center

    Dowd, Steven B.

    The current emphasis in education on accountability is tending toward "push-button accountability." The challenge is to evaluate access and retention as well as other educationally relevant goals to define "quality" or "accountability." In higher education, accountability should be proven through assessment and should consist of proof that what…

  7. Financial accounting for radiology executives.

    PubMed

    Seidmann, Abraham; Mehta, Tushar

    2005-03-01

    The authors review the role of financial accounting information from the perspective of a radiology executive. They begin by introducing the role of pro forma statements. They discuss the fundamental concepts of accounting, including the matching principle and accrual accounting. The authors then explore the use of financial accounting information in making investment decisions in diagnostic medical imaging. The paper focuses on critically evaluating the benefits and limitations of financial accounting for decision making in a radiology practice.

  8. 13 CFR 120.463 - Regulatory accounting-What are SBA's regulatory accounting requirements for SBA Supervised Lenders?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... basis in accordance with Generally Accepted Accounting Principles (GAAP) as promulgated by the Financial Accounting Standards Board (FASB), supplemented by Regulatory Accounting Principles (RAP) as identified by... set forth in FASB Statement of Financial Accounting Standards No. 15, Accounting by Debtors and...

  9. 75 FR 20363 - Notice of Issuance of Statement of Federal Financial Accounting Standard 38, Accounting for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-19

    ... FEDERAL ACCOUNTING STANDARDS ADVISORY BOARD Notice of Issuance of Statement of Federal Financial Accounting Standard 38, Accounting for Federal Oil and Gas Resources AGENCY: Federal Accounting Standards... is hereby given that the Federal Accounting Standards Advisory Board (FASAB) has issued Statement of...

  10. Implementing Replacement Cost Accounting

    DTIC Science & Technology

    1976-12-01

    cost accounting Clickener, John Ross Monterey, California. Naval Postgraduate School http://hdl.handle.net/10945/17810 Downloaded from NPS Archive...Calhoun IMPLEMENTING REPLACEMENT COST ACCOUNTING John Ross CHckener NAVAL POSTGRADUATE SCHOOL Monterey, California THESIS IMPLEMENTING REPLACEMENT COST ...Implementing Replacement Cost Accounting 7. AUTHORS John Ross Clickener READ INSTRUCTIONS BEFORE COMPLETING FORM 3. RECIPIENT’S CATALOG NUMBER 9. TYRE OF

  11. Accounting Education in Crisis

    ERIC Educational Resources Information Center

    Turner, Karen F.; Reed, Ronald O.; Greiman, Janel

    2011-01-01

    Almost on a daily basis new accounting rules and laws are put into use, creating information that must be known and learned by the accounting faculty and then introduced to and understood by the accounting student. Even with the 150 hours of education now required for CPA licensure, it is impossible to teach and learn all there is to learn. Over…

  12. Where Are the Accounting Professors?

    ERIC Educational Resources Information Center

    Chang, Jui-Chin; Sun, Huey-Lian

    2008-01-01

    Accounting education is facing a crisis of shortage of accounting faculty. This study discusses the reasons behind the shortage and offers suggestions to increase the supply of accounting faculty. Our suggestions are as followings. First, educators should begin promoting accounting academia as one of the career choices to undergraduate and…

  13. Accountability: A Bibliography.

    ERIC Educational Resources Information Center

    Hanson, Gordon; Gold, James

    This bibliography, the 6th in a series of reports dealing with accountability, is designed to provide those interested in assessment and accountability with a ready reference for identifying articles relevant to their individual needs. The citations are listed under a general section, the ERIC files section, and the CAP section. Entries within…

  14. Public Accountancy Handbook.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Office of the Professions.

    The laws, rules and regulations of the State Education Department governing public accountancy practice in New York State are provided in this handbook. Licensure requirements are also described, and the forms for obtaining a license and first registration as a certified public accountant are provided. The booklet is divided into the following…

  15. User Accounts | High-Performance Computing | NREL

    Science.gov Websites

    see information on user account policies. ACCOUNT PASSWORDS Logging in for the first time? Forgot your Accounts User Accounts Learn how to request an NREL HPC user account. Request an HPC Account To request an HPC account, please complete our request form. This form is provided using DocuSign. REQUEST

  16. Accountability and Primary Healthcare

    PubMed Central

    Mukhi, Shaheena; Barnsley, Jan; Deber, Raisa B.

    2014-01-01

    This paper examines the accountability structures within primary healthcare (PHC) in Ontario; in particular, who is accountable for what and to whom, and the policy tools being used. Ontario has implemented a series of incremental reforms, using expenditure policy instruments, enforced through contractual agreements to provide a defined set of publicly financed services that are privately delivered, most often by family physicians. The findings indicate that reporting, funding, evaluation and governance accountability requirements vary across service provider models. Accountability to the funder and patients is most common. Agreements, incentives and compensation tools have been used but may be insufficient to ensure parties are being held responsible for their activities related to stated goals. Clear definitions of various governance structures, a cohesive approach to monitoring critical performance indicators and associated improvement strategies are important elements in operationalizing accountability and determining whether goals are being met. PMID:25305392

  17. Fungal spores overwhelm biogenic organic aerosols in a midlatitudinal forest

    NASA Astrophysics Data System (ADS)

    Zhu, Chunmao; Kawamura, Kimitaka; Fukuda, Yasuro; Mochida, Michihiro; Iwamoto, Yoko

    2016-06-01

    Both primary biological aerosol particles (PBAPs) and oxidation products of biogenic volatile organic compounds (BVOCs) contribute significantly to organic aerosols (OAs) in forested regions. However, little is known about their relative importance in diurnal timescales. Here, we report biomarkers of PBAP and secondary organic aerosols (SOAs) for their diurnal variability in a temperate coniferous forest in Wakayama, Japan. Tracers of fungal spores, trehalose, arabitol and mannitol, showed significantly higher levels in nighttime than daytime (p < 0.05), resulting from the nocturnal sporulation under near-saturated relative humidity. On the contrary, BVOC oxidation products showed higher levels in daytime than nighttime, indicating substantial photochemical SOA formation. Using tracer-based methods, we estimated that fungal spores account for 45 % of organic carbon (OC) in nighttime and 22 % in daytime, whereas BVOC oxidation products account for 15 and 19 %, respectively. To our knowledge, we present for the first time highly time-resolved results that fungal spores overwhelmed BVOC oxidation products in contributing to OA especially in nighttime. This study emphasizes the importance of both PBAPs and SOAs in forming forest organic aerosols.

  18. Effects of residual organics in municipal wastewater on hydrogenotrophic denitrifying microbial communities.

    PubMed

    Xing, Wei; Li, Jinlong; Li, Peng; Wang, Chong; Cao, Yanan; Li, Desheng; Yang, Yunfeng; Zhou, Jizhong; Zuo, Jiane

    2018-03-01

    Hydrogenotrophic denitrification is promising for tertiary nitrogen removal from municipal wastewater. To reveal the influence of residual organics in municipal wastewater on hydrogenotrophic denitrifiers, we adopted high-throughput 16S rRNA gene amplicon sequencing to examine microbial communities in hydrogenotrophic denitrification enrichments. Using effluent from a municipal wastewater treatment plant as water source, COD, nitrate and pH were controlled the same except for a gradient of biodegradable carbon (i.e., primary effluent (PE), secondary effluent (SE), or combined primary and secondary effluent (CE)). Inorganic synthetic water (IW) was used as a control. Hydrogenophaga, a major facultative autotroph, accounted for 17.1%, 5.3%, 32.7% and 12.9% of the sequences in PE, CE, SE and IW, respectively, implicating that Hydrogenophaga grew well with or without organics. Thauera, which contains likely obligate autotrophic denitrifiers, appeared to be the most dominant genera (23.6%) in IW and accounted for 2.5%, 4.6% and 8.9% in PE, CE and SE, respectively. Thermomonas, which is related to heterotrophic denitrification, accounted for 4.2% and 7.9% in PE and CE fed with a higher content of labile organics, respectively. In contrast, Thermomonas was not detected in IW and accounted for only 0.6% in SE. Our results suggest that Thermomonas are more competitive than Thauera in hydrogenotrophic denitrification with biodegradable organics. Moreover, facultative autotrophic denitrifiers, Hydrogenophaga, are accommodating to residual organic in effluent wastewater, thus we propose that hydrogenotrophic denitrification is amenable for tertiary nitrogen removal. Copyright © 2017. Published by Elsevier B.V.

  19. Removal of Organic Pollutants from Water Using Superwetting Materials.

    PubMed

    Li, Lingxiao; Zhang, Junping; Wang, Aiqin

    2018-02-01

    The frequent occurrence of water pollution accidents and the leakage of organic pollutants have caused severe environmental and ecological crisis. It is thus highly imperative to find efficient materials to solve the problem. Inspired by the lotus leaf, superwetting materials are receiving increasing attention in the field of removal of organic pollutants from water. Various superwetting materials have been successfully generated and integrated into devices for removal of organic pollutants from water. On the basis of our previous work in the field, we summarized in this account the progress of removal of (1) floating and underwater insoluble, (2) emulsified insoluble, and (3) both insoluble and soluble organic pollutants from water using superwetting materials including superhydrophobic & superoleophilic materials, superhydrophilic & underwater superoleophobic materials, and materials with controllable wettability. The superwetting materials are in the forms of 2D porous materials, 3D porous materials and particles, etc. Finally, the current state and future challenges in this field are discussed. We hope this account could shed light on the design of novel superwetting materials for efficient removal of organic pollutants from water. © 2018 The Chemical Society of Japan & Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  20. Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States.

    PubMed

    Goldberg, D; Kallan, M J; Fu, L; Ciccarone, M; Ramirez, J; Rosenberg, P; Arnold, J; Segal, G; Moritsugu, K P; Nathan, H; Hasz, R; Abt, P L

    2017-12-01

    The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient-level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009-2012, 96,028 (3.3%) were a "possible deceased-organ donor." The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased-donors who become actual donors; range: 20.0-57.0%); and (2) organs transplanted per possible donor (range: 0.52-1.74). These metrics allow for comparisons of OPO performance and geographic-level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  1. Just Culture: A Foundation for Balanced Accountability and Patient Safety

    PubMed Central

    Boysen, Philip G.

    2013-01-01

    Background The framework of a just culture ensures balanced accountability for both individuals and the organization responsible for designing and improving systems in the workplace. Engineering principles and human factors analysis influence the design of these systems so they are safe and reliable. Methods Approaches for improving patient safety introduced here are (1) analysis of error, (2) specific tools to enhance safety, and (3) outcome engineering. Conclusion The just culture is a learning culture that is constantly improving and oriented toward patient safety. PMID:24052772

  2. Ideas for the Accounting Classroom.

    ERIC Educational Resources Information Center

    Kerby, Debra; Romine, Jeff

    2003-01-01

    Innovative ideas for accounting education include having students study accounting across historical periods, using businesses for student research, exploring nontraditional accounting careers, and collaborating with professional associations. (SK)

  3. 17 CFR 247.723 - Exemptions for special accounts, transferred accounts, foreign branches and a de minimis number...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... accounts, transferred accounts, foreign branches and a de minimis number of accounts. 247.723 Section 247... Exemptions for special accounts, transferred accounts, foreign branches and a de minimis number of accounts... dealer. (e) De minimis exclusion. A bank may, in determining its compliance with the chiefly compensated...

  4. 17 CFR 247.723 - Exemptions for special accounts, transferred accounts, foreign branches and a de minimis number...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... accounts, transferred accounts, foreign branches and a de minimis number of accounts. 247.723 Section 247... Exemptions for special accounts, transferred accounts, foreign branches and a de minimis number of accounts... dealer. (e) De minimis exclusion. A bank may, in determining its compliance with the chiefly compensated...

  5. Government influence on patient organizations.

    PubMed

    Van de Bovenkamp, Hester M; Trappenburg, Margo J

    2011-12-01

    Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care providers, health insurers and the pharmaceutical industry. To strengthen the position of patient organizations government funding is often recommended as a solution. In this paper we analyze the ties between Dutch government and Dutch patient organizations to learn more about the effects of such a relationship between government and this part of civil society. Our study is based on official government documents and existing empirical research on patient organizations. We found that government influence on patient organizations has become quite substantial with government influencing the organizational structure of patient organizations, the activities these organizations perform and even their ideology. Financing patient organizations offers the government an important means to hold them accountable. Although the ties between patient organizations and the government enable the former to play a role that can be valued as positive by both parties, we argue that they raise problems as well which warrant a discussion on how much government influence on civil society is acceptable.

  6. Calculation of NMR chemical shifts in organic solids: accounting for motional effects.

    PubMed

    Dumez, Jean-Nicolas; Pickard, Chris J

    2009-03-14

    NMR chemical shifts were calculated from first principles for well defined crystalline organic solids. These density functional theory calculations were carried out within the plane-wave pseudopotential framework, in which truly extended systems are implicitly considered. The influence of motional effects was assessed by averaging over vibrational modes or over snapshots taken from ab initio molecular dynamics simulations. It is observed that the zero-point correction to chemical shifts can be significant, and that thermal effects are particularly noticeable for shielding anisotropies and for a temperature-dependent chemical shift. This study provides insight into the development of highly accurate first principles calculations of chemical shifts in solids, highlighting the role of motional effects on well defined systems.

  7. Accountability

    ERIC Educational Resources Information Center

    Fielding, Michael; Inglis, Fred

    2017-01-01

    This contribution republishes extracts from two important articles published around 2000 concerning the punitive accountability system suffered by English primary and secondary schools. The first concerns the inspection agency Ofsted, and the second managerialism. Though they do not directly address assessment, they are highly relevant to this…

  8. Rules and Self-Organizing Properties of Post-embryonic Plant Organ Cell Division Patterns.

    PubMed

    von Wangenheim, Daniel; Fangerau, Jens; Schmitz, Alexander; Smith, Richard S; Leitte, Heike; Stelzer, Ernst H K; Maizel, Alexis

    2016-02-22

    Plants form new organs with patterned tissue organization throughout their lifespan. It is unknown whether this robust post-embryonic organ formation results from stereotypic dynamic processes, in which the arrangement of cells follows rigid rules. Here, we combine modeling with empirical observations of whole-organ development to identify the principles governing lateral root formation in Arabidopsis. Lateral roots derive from a small pool of founder cells in which some take a dominant role as seen by lineage tracing. The first division of the founders is asymmetric, tightly regulated, and determines the formation of a layered structure. Whereas the pattern of subsequent cell divisions is not stereotypic between different samples, it is characterized by a regular switch in division plane orientation. This switch is also necessary for the appearance of patterned layers as a result of the apical growth of the primordium. Our data suggest that lateral root morphogenesis is based on a limited set of rules. They determine cell growth and division orientation. The organ-level coupling of the cell behavior ensures the emergence of the lateral root's characteristic features. We propose that self-organizing, non-deterministic modes of development account for the robustness of plant organ morphogenesis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Defining Peer-to-Peer Accountability From the Nurse's Perspective.

    PubMed

    Lockett, Jacqueline Jansen; Barkley, Leslie; Stichler, Jaynelle; Palomo, Jeanne; Kik, Bozena; Walker, Christopher; Donnelly, Janet; Willon, Judy; Sanborn, Julie; O'Byrne, Noeleen

    2015-11-01

    The aim of this study was to define and create a conceptual model for peer-to-peer accountability (P to PA). Many organizations cite the importance of peer accountability (PA) as essential in ensuring patient safety. Professionalism in nursing requires self-regulation of practice and PA. Although discussed in the literature, P to PA is not conceptually defined. A grounded theory study design with constant comparative data collection and analysis was used to explore nurses' definitions of P to PA and their perceptions of motivators and barriers to engaging in P to PA. Transcripts of digital recordings of all interviews were analyzed using line-by-line coding until identified themes emerged. P to PA was defined as the act of speaking up when one observes a peer not practicing to acceptable standards. A conceptual model illustrates the antecedents, attributes, and consequences of P to PA. P to PA is the professional responsibility of every nurse and healthcare provider and is essential for safe patient care. The conceptual definition facilitates actualization of P to PA in practice.

  10. Accounting for health-care outcomes: implications for intensive care unit practice and performance.

    PubMed

    Sorensen, Roslyn; Iedema, Rick

    2010-08-01

    The aim of this study was to understand the environment of health care, and how clinicians and managers respond in terms of performance accountability. A qualitative method was used in a tertiary metropolitan teaching intensive care unit (ICU) in Sydney, Australia, including interviews with 15 clinical managers and focus groups with 29 nurses of differing experience. The study found that a managerial focus on abstract goals, such as budgets detracted from managing the core business of clinical work. Fractures were evident within clinical units, between clinical units and between clinical and managerial domains. These fractures reinforced the status quo where seemingly unconnected patient care activities were undertaken by loosely connected individual clinicians with personalized concepts of accountability. Managers must conceptualize health services as an interconnected entity within which self-directed teams negotiate and agree objectives, collect and review performance data and define collective practice. Organically developing regimens of care within and across specialist clinical units, such as in ICUs, directly impact upon health service performance and accountability.

  11. How youth-serving organizations enable acquaintance molesters.

    PubMed

    Boyle, Patrick

    2014-10-01

    In recent years, some of the country's most prominent institutions have been ensnared in child sex abuse scandals. While each abuse incident features its own particular circumstances, institutions that have been the subject of these scandals have displayed similar patterns of organizational behavior that allowed molesting to occur and molesters to escape accountability. We can learn from those patterns to better understand and combat acquaintance molestation in youth-serving organizations. Although sex abuse is an inherent risk in youth work, American youth-serving organizations have responded to this risk largely on a case-by-case basis after abuse incidents have been revealed, rather than through proactive strategies to reduce the risk of abuse and to respond effectively to allegations. An examination of abuse scandals reveals common patterns of behavior among paid and volunteer staff in organizations that did not enact comprehensive, proactive strategies: Faith in the organiation blinded staff to the liklihood of abuse; organizations kept workers ignorant about the extent of the abuse problem; when abuse accusations arose, staff gave the benefit of the doubt to the adult; when abuse accusations were confirmed, staffers did not know how to respond; and not knowing how to resopnd, staff prioritized the protection of the organization. As a result, child molesters have been falsely exonerated or not held accountable, abused children have been disbelieved, and abuse has continued. These organizations inadvertently achieved the opposite of their missions: They enabled child molesters at the expense of children. © The Author(s) 2014.

  12. Scientifically supported mental health intervention in schools: meeting accountability demands with an online resource.

    PubMed

    Powers, Joelle D

    2012-01-01

    Legislation has been passed that holds schools increasingly accountable for the proficiency of all students, including those with mental health problems. A critical obstacle impeding the ability of schools to effectively support students is the lack of access to quick, pre-screened, and organized information about scientifically-supported interventions that effectively address youth mental health problems. A new mental health best practices database was developed and made available online that provides access to free and user-friendly information about evidence-based interventions for use in schools. School staff will be better able to meet accountability demands of legislation and to effectively respond to student mental health problems.

  13. 7 CFR 1770.13 - Accounting requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Accounting requirements. 1770.13 Section 1770.13... AGRICULTURE (CONTINUED) ACCOUNTING REQUIREMENTS FOR RUS TELECOMMUNICATIONS BORROWERS Uniform System of Accounts § 1770.13 Accounting requirements. (a) Each borrower shall maintain its books of accounts on the...

  14. The Impact of the Principles of Accounting Experience on Student Preparation for Intermediate Accounting

    ERIC Educational Resources Information Center

    Carrington, Linda G.

    2012-01-01

    Both students and instructors alike will generally agree that intermediate accounting courses are among the most difficult and demanding in an accounting or finance curriculum, and perhaps even on the college campus. Intermediate accounting contains subject matter which requires a higher level of thinking and a greater ability to process prior…

  15. The Function and Organization of Lateral Prefrontal Cortex: A Test of Competing Hypotheses

    PubMed Central

    Reynolds, Jeremy R.; O'Reilly, Randall C.; Cohen, Jonathan D.; Braver, Todd S.

    2012-01-01

    The present experiment tested three hypotheses regarding the function and organization of lateral prefrontal cortex (PFC). The first account (the information cascade hypothesis) suggests that the anterior-posterior organization of lateral PFC is based on the timing with which cue stimuli reduce uncertainty in the action selection process. The second account (the levels-of-abstraction hypothesis) suggests that the anterior-posterior organization of lateral PFC is based on the degree of abstraction of the task goals. The current study began by investigating these two hypotheses, and identified several areas of lateral PFC that were predicted to be active by both the information cascade and levels-of-abstraction accounts. However, the pattern of activation across experimental conditions was inconsistent with both theoretical accounts. Specifically, an anterior area of mid-dorsolateral PFC exhibited sensitivity to experimental conditions that, according to both accounts, should have selectively engaged only posterior areas of PFC. We therefore investigated a third possible account (the adaptive context maintenance hypothesis) that postulates that both posterior and anterior regions of PFC are reliably engaged in task conditions requiring active maintenance of contextual information, with the temporal dynamics of activity in these regions flexibly tracking the duration of maintenance demands. Activity patterns in lateral PFC were consistent with this third hypothesis: regions across lateral PFC exhibited transient activation when contextual information had to be updated and maintained in a trial-by-trial manner, but sustained activation when contextual information had to be maintained over a series of trials. These findings prompt a reconceptualization of current views regarding the anterior-posterior organization of lateral PFC, but do support other findings regarding the active maintenance role of lateral PFC in sequential working memory paradigms. PMID:22355309

  16. 32 CFR 623.4 - Accounting procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Accounting procedures. 623.4 Section 623.4... ARMY MATERIEL § 623.4 Accounting procedures. (a) Loan document format. (1) When the lending accountable... property accounting purposes. (3) Loans will be processed by accountable property officers according to...

  17. 76 FR 61660 - Cost Accounting Standards: Clarification of the Exemption From Cost Accounting Standards for Firm...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-05

    ... Accounting Standards: Clarification of the Exemption From Cost Accounting Standards for Firm-Fixed-Price... Management and Budget (OMB), Office of Federal Procurement Policy, Cost Accounting Standards Board. ACTION: Proposed rule. SUMMARY: The Office of Federal Procurement Policy (OFPP), Cost Accounting Standards (CAS...

  18. 77 FR 69422 - Cost Accounting Standards: Revision of the Exemption From Cost Accounting Standards for Contracts...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-19

    ... Accounting Standards: Revision of the Exemption From Cost Accounting Standards for Contracts and Subcontracts... Federal Procurement Policy (OFPP), Cost Accounting Standards (CAS) Board. ACTION: Proposed rule. SUMMARY... J. M. Wong, Director, Cost Accounting Standards Board (telephone: 202-395-6805; email: Raymond_wong...

  19. Accounting for the environment.

    PubMed

    Lutz, E; Munasinghe, M

    1991-03-01

    Environmental awareness in the 1980s has led to efforts to improve the current UN System of National Accounts (SNA) for better measurement of the value of environmental resources when estimating income. National governments, the UN, the International Monetary Fund, and the World Bank are interested in solving this issue. The World Bank relies heavily on national aggregates in income accounts compiled by means of the SNA that was published in 1968 and stressed gross domestic product (GDP). GDP measures mainly market activity, but it takes does not consider the consumption of natural capital, and indirectly inhibits sustained development. The deficiencies of the current method of accounting are inconsistent treatment of manmade and natural capital, the omission of natural resources and their depletion from balance sheets, and pollution cleanup costs from national income. In the calculation of GDP pollution is overlooked, and beneficial environmental inputs are valued at zero. The calculation of environmentally adjusted net domestic product (EDP) and environmentally adjusted net income (ENI) would lower income and growth rate, as the World Resources Institute found with respect to Indonesia for 1971-84. When depreciation for oil, timber, and top soil was included the net domestic product (NDP) was only 4% compared with a 7.1% GDP. The World Bank has advocated environmental accounting since 1983 in SNA revisions. The 1989 revised Blue Book of the SNA takes environment concerns into account. Relevant research is under way in Mexico and Papua New Guinea using the UN Statistical Office framework as a system for environmentally adjusted economic accounts that computes EDP and ENI and integrates environmental data with national accounts while preserving SNA concepts.

  20. 7 CFR 1902.15 - Closing accounts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Closing accounts. 1902.15 Section 1902.15 Agriculture... SUPERVISED BANK ACCOUNTS Supervised Bank Accounts of Loan, Grant, and Other Funds § 1902.15 Closing accounts... consent (and of another lender or grantor, if involved) to close the supervised bank account in the...

  1. 17 CFR 229.304 - (Item 304) Changes in and disagreements with accountants on accounting and financial disclosure.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... disagreements with accountants on accounting and financial disclosure. 229.304 Section 229.304 Commodity and...-REGULATION S-K Financial Information § 229.304 (Item 304) Changes in and disagreements with accountants on... subsequent interim period, an independent accountant who was previously engaged as the principal accountant...

  2. 17 CFR 229.304 - (Item 304) Changes in and disagreements with accountants on accounting and financial disclosure.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... disagreements with accountants on accounting and financial disclosure. 229.304 Section 229.304 Commodity and...-REGULATION S-K Financial Information § 229.304 (Item 304) Changes in and disagreements with accountants on... subsequent interim period, an independent accountant who was previously engaged as the principal accountant...

  3. 17 CFR 229.304 - (Item 304) Changes in and disagreements with accountants on accounting and financial disclosure.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... disagreements with accountants on accounting and financial disclosure. 229.304 Section 229.304 Commodity and...-REGULATION S-K Financial Information § 229.304 (Item 304) Changes in and disagreements with accountants on... subsequent interim period, an independent accountant who was previously engaged as the principal accountant...

  4. 17 CFR 229.304 - (Item 304) Changes in and disagreements with accountants on accounting and financial disclosure.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... disagreements with accountants on accounting and financial disclosure. 229.304 Section 229.304 Commodity and...-REGULATION S-K Financial Information § 229.304 (Item 304) Changes in and disagreements with accountants on... subsequent interim period, an independent accountant who was previously engaged as the principal accountant...

  5. How to Professionalize Accounting Programs

    ERIC Educational Resources Information Center

    Allyn, Robert G.

    1977-01-01

    The author, a certified public accountant on the State Board for Public Accountancy of New York, Discusses education and training programs to "professionalize" accounting, particularly the need for innovative learning modules that integrate the traditional sequence of courses in baccalaureate programs. (MF)

  6. 12 CFR 218.723 - Exemptions for special accounts, transferred accounts, foreign branches and a de minimis number...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... accounts, foreign branches and a de minimis number of accounts. 218.723 Section 218.723 Banks and Banking... accounts, transferred accounts, foreign branches and a de minimis number of accounts. (a) Short-term... dealer. (e) De minimis exclusion. A bank may, in determining its compliance with the chiefly compensated...

  7. 12 CFR 218.723 - Exemptions for special accounts, transferred accounts, foreign branches and a de minimis number...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... accounts, foreign branches and a de minimis number of accounts. 218.723 Section 218.723 Banks and Banking... accounts, transferred accounts, foreign branches and a de minimis number of accounts. (a) Short-term... dealer. (e) De minimis exclusion. A bank may, in determining its compliance with the chiefly compensated...

  8. 24 CFR 3500.17 - Escrow accounts.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... means an amount by which a current escrow account balance falls short of the target balance at the time...). Deficiency is the amount of a negative balance in an escrow account. As noted in § 3500.17(f), if a servicer... escrow account. Escrow account means any account that a servicer establishes or controls on behalf of a...

  9. Accounting Students Are Unable to Recognize the Various Types of Accounting Functions.

    ERIC Educational Resources Information Center

    Frank, Gary B.; And Others

    1989-01-01

    The authors discuss 258 undergraduate business majors' perceptions of the nature and uses of financial and managerial accounting. Perceptions were measured with Stapel Scales constructed on 11 descriptive statements. Findings indicated that students distinguish between financial and managerial accounting, but that they do not view the two as…

  10. Teaching Undergraduate Accounting Majors How to Interpret the Accounting Standards Codification: An Alternative to Research Cases

    ERIC Educational Resources Information Center

    Toerner, Michael C.; Swindle, C. Bruce; Burckel, Daryl V.

    2014-01-01

    Professional accountants regularly search the FASB'S Accounting Standards Codification to find answers to financial accounting questions. Accounting educators know this and frequently use research cases in an attempt to help students begin developing this ability. But many students struggle with these cases because they have not been taught how to…

  11. Quality of Care Improves for Patients with Diabetes in Medicare Shared Savings Accountable Care Organizations: Organizational Characteristics Associated with Performance.

    PubMed

    Fraze, Taressa K; Lewis, Valerie A; Tierney, Emily; Colla, Carrie H

    2017-12-06

    Accountable care organizations (ACOs), a primary care-centric delivery and payment model, aim to promote integrated population health, which may improve care for those with chronic conditions such as diabetes. Research has shown that, overall, the ACO model is effective at reducing costs, but there is substantial variation in how effective different types of ACOs are at impacting costs and improving care delivery. This study examines how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes. Secondary data were analyzed retrospectively to examine Medicare Shared Savings Program (MSSP) ACOs' performance on diabetes metrics in the first 2 years of ACO contracts. Ordinary least squares was used to analyze 162 MSSP ACOs with publicly available performance data and the National Survey of ACOs. ACOs improved performance significantly for patients with diabetes between contract years 1 and 2. In year 1, also having a private payer contract and an increased number of services within the ACO were positively associated with performance, while having a community health center or a hospital were negatively associated with performance. Better performance in year 1 was negatively associated with improved performance in year 2. This study found that ACOs substantively improved diabetes management within initial contract years. ACOs may need different types of support throughout their contracts to ensure continued improvements in performance.

  12. 40 CFR 97.420 - Establishment of compliance accounts, assurance accounts, and general accounts.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... representation under § 97.416, the Administrator will establish a compliance account for the TR NOX Annual source for which the certificate of representation was submitted, unless the source already has a compliance... such persons and that each such person shall be fully bound by my representations, actions, inactions...

  13. Accounting Systems for School Districts.

    ERIC Educational Resources Information Center

    Atwood, E. Barrett, Jr.

    1983-01-01

    Advises careful analysis and improvement of existing school district accounting systems prior to investment in new ones. Emphasizes the importance of attracting and maintaining quality financial staffs, developing an accounting policies and procedures manual, and designing a good core accounting system before purchasing computer hardware and…

  14. Accountability: A Mosaic Image

    ERIC Educational Resources Information Center

    Turner, Teri

    1977-01-01

    The problems involved in definition, implementation and control of accountability processes are discussed. It is stated that "...emotional involvement in accountability is one of the most difficult aspects to deal with, the chief emotion being fear". (Author/RW)

  15. 25 CFR 115.801 - How often will a tribe receive information about its trust account(s)?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... a tribe receive information about its trust account(s)? The OTFM is required to provide each tribe... 25 Indians 1 2010-04-01 2010-04-01 false How often will a tribe receive information about its trust account(s)? 115.801 Section 115.801 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR...

  16. 48 CFR 204.7107 - Contract accounting classification reference number (ACRN) and agency accounting identifier (AAI).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Contract accounting classification reference number (ACRN) and agency accounting identifier (AAI). 204.7107 Section 204.7107 Federal... ADMINISTRATIVE MATTERS Uniform Contract Line Item Numbering System 204.7107 Contract accounting classification...

  17. 48 CFR 204.7107 - Contract accounting classification reference number (ACRN) and agency accounting identifier (AAI).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Contract accounting classification reference number (ACRN) and agency accounting identifier (AAI). 204.7107 Section 204.7107 Federal... ADMINISTRATIVE MATTERS Uniform Contract Line Item Numbering System 204.7107 Contract accounting classification...

  18. Leaders Learning from Leaders as an Emergent Action Learning Strategy Type of Paper: Account of Practice

    ERIC Educational Resources Information Center

    Mullen, Carol A.; Rodríguez, Mariela A.; Allen, Tawannah G.

    2015-01-01

    This account of practice describes what three executive leaders in a professional association have learned about action learning and their own practices of organizational renewal. Data are approached narratively and stories are told from the perspectives of diverse educators' experiences, agency, and expertise. Mature organizations can be…

  19. Re-Balancing Assessment: Placing Formative and Performance Assessment at the Heart of Learning and Accountability

    ERIC Educational Resources Information Center

    Hofman, Peter; Goodwin, Bryan; Kahl, Stuart

    2015-01-01

    These days, a growing chorus of parents, educators, and policymakers is voicing frustration and anger with top-down accountability and high-stakes testing. As members of two not-for-profit education organizations--one focused on assessment and the other on research and instructional practices--the authors find nothing wrong with testing itself;…

  20. 47 CFR 36.331 - Information origination/termination expenses-Account 6310 (Class B telephone companies); Accounts...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... telephone companies). (a) The expenses in this account are classified as follows: (1) Other Information... 47 Telecommunication 2 2010-10-01 2010-10-01 false Information origination/termination expenses-Account 6310 (Class B telephone companies); Accounts 6311, 6341, 6351, and 6362 (Class A telephone...

  1. 40 CFR 97.620 - Establishment of compliance accounts, assurance accounts, and general accounts.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... representation under § 97.616, the Administrator will establish a compliance account for the TR SO2 Group 1 source for which the certificate of representation was submitted, unless the source already has a... such persons and that each such person shall be fully bound by my representations, actions, inactions...

  2. 40 CFR 97.720 - Establishment of compliance accounts, assurance accounts, and general accounts.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... representation under § 97.716, the Administrator will establish a compliance account for the TR SO2 Group 2 source for which the certificate of representation was submitted, unless the source already has a... such persons and that each such person shall be fully bound by my representations, actions, inactions...

  3. 40 CFR 97.520 - Establishment of compliance accounts, assurance accounts, and general accounts.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... representation under § 97.516, the Administrator will establish a compliance account for the TR NOX Ozone Season source for which the certificate of representation was submitted, unless the source already has a... Program on behalf of such persons and that each such person shall be fully bound by my representations...

  4. Organic Nitrate Contribution to New Particle Formation and Growth in Secondary Organic Aerosols from α-Pinene Ozonolysis.

    PubMed

    Berkemeier, Thomas; Ammann, Markus; Mentel, Thomas F; Pöschl, Ulrich; Shiraiwa, Manabu

    2016-06-21

    The chemical kinetics of organic nitrate production during new particle formation and growth of secondary organic aerosols (SOA) were investigated using the short-lived radioactive tracer (13)N in flow-reactor studies of α-pinene oxidation with ozone. Direct and quantitative measurements of the nitrogen content indicate that organic nitrates accounted for ∼40% of SOA mass during initial particle formation, decreasing to ∼15% upon particle growth to the accumulation-mode size range (>100 nm). Experiments with OH scavengers and kinetic model results suggest that organic peroxy radicals formed by α-pinene reacting with secondary OH from ozonolysis are key intermediates in the organic nitrate formation process. The direct reaction of α-pinene with NO3 was found to be less important for particle-phase organic nitrate formation. The nitrogen content of SOA particles decreased slightly upon increase of relative humidity up to 80%. The experiments show a tight correlation between organic nitrate content and SOA particle-number concentrations, implying that the condensing organic nitrates are among the extremely low volatility organic compounds (ELVOC) that may play an important role in the nucleation and growth of atmospheric nanoparticles.

  5. Should It Stay or Should It Go: How Successful Superintendents Build, Shift, and Transform District Culture in an Age of Increasing Accountability

    ERIC Educational Resources Information Center

    Arnold, Joshua F.

    2013-01-01

    The purpose of this study was to gain information regarding the manner in which superintendents build, shift, and transform district culture in an age of increasing accountability so that the new values and past practices of the organization work in concert with each other to match the culture of educational accountability sweeping the nation.…

  6. 18 CFR 367.1440 - Account 144, Accumulated provision for uncollectible accounts-Credit.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT UNIFORM SYSTEM OF ACCOUNTS FOR CENTRALIZED SERVICE COMPANIES SUBJECT TO THE PROVISIONS OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT Balance Sheet Chart of Accounts Current and Accrued Assets § 367...

  7. Accountability among Baccalaureate Nursing Students: Definitions, Perceptions, and Engagement Practices of Accountability

    ERIC Educational Resources Information Center

    Ort, Jennifer Ann

    2016-01-01

    To ensure optimal patient care an especially high level of accountability is required when entering the workforce. The purpose of this qualitative study was to explore, describe, and define perceptions of accountability as described by sophomore and senior nursing students in two baccalaureate nursing programs. The research questions aimed to (a)…

  8. The Deviant Organization and the Bad Apple CEO: Ideology and Accountability in Media Coverage of Corporate Scandals

    ERIC Educational Resources Information Center

    Benediktsson, Michael Owen

    2010-01-01

    What role do the media play in the identification and construction of white-collar crimes? Few studies have examined media coverage of corporate deviance. This study investigates news coverage of six large-scale accounting scandals that broke in 2001 and 2002. Using a variety of empirical methods to analyze the 51 largest U.S. newspapers, the…

  9. An Accounting Writing Proficiency Survey

    ERIC Educational Resources Information Center

    Firch, Tim; Campbell, Annhenrie; Filling, Steven; Lindsay, David H.

    2011-01-01

    Although there has been much discussion about improving college student writing with college-level courses, little is known about how accounting programs, in particular, are addressing the writing proficiency challenge. This study surveys the 852 accounting programs in the United States to identify the frequency and types of accounting writing…

  10. User-Oriented Project Accounting System.

    ERIC Educational Resources Information Center

    Hess, Larry G.; Alcorn, Lisa S.

    1990-01-01

    The project accounting system used by the University of Illinois Urbana-Champaign School of Chemical Sciences exchanges financial data with the campus' central accounting system and allows integration of this information with user-entered data to produce an easily read, fully obligated project accounting statement for the budget and period…

  11. 46 CFR Sec. 5 - Accounting.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Accounting. Sec. 5 Section 5 Shipping MARITIME... Sec. 5 Accounting. The General Agent shall record the amounts of compensation paid from the NSA... Accounting Office, at which time the Maritime Administration will take custody of the records. [16 FR 2885...

  12. 7 CFR 946.42 - Accounting.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Accounting. 946.42 Section 946.42 Agriculture... Order Regulating Handling Expenses and Assessments § 946.42 Accounting. (a) Excess funds. At the end of... the addition, if any, to the operating reserve. (b) Accounting of funds upon termination of order. Any...

  13. 75 FR 64684 - Cost Accounting Standards: Elimination of the Exemption From Cost Accounting Standards for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-20

    ... financial accounting practices and internal controls. Consistency will be better served by all companies... such as the ownership and control of the company, and whether the contractor's accounting activities... argues that there must be some type of accounting system in foreign entities to ensure that billings...

  14. Making sense of diversity in the workplace: organizational justice and language abstraction in employees' accounts of diversity-related incidents.

    PubMed

    Roberson, Quinetta M; Stevens, Cynthia Kay

    2006-03-01

    To discern patterns of employee sense-making about workplace diversity, the authors analyzed 751 natural language accounts of diversity incidents from 712 workers in one department of a large organization. Six generic incident types emerged: discrimination, representation, treatment by management, work relationships, respect between groups, and diversity climates. Consistent with hypotheses, incidents that respondents viewed as negative, accounts from women, and those involving members of respondents' in-groups were more likely to cite justice issues. Partially consistent with research on the linguistic intergroup bias, both negative and positive accounts involving out-group members and accounts from men were more likely to be expressed using abstract verb forms. The authors discuss future opportunities to integrate research on diversity, justice, and the linguistic category model.

  15. [Organization, functioning and expectations of organizations representing patients. Survey of key informants].

    PubMed

    García-Sempere, Aníbal; Artells, Juan José

    2005-01-01

    To explore patient organizations and their scope in terms of patient and user participation in decisions affecting their health. Semi-structured questionnaire survey of key informants from 21 patient organizations. Most of the patient organizations were regional or national private organizations. Their main objectives include improving quality of life and representing the interests of patients and their families, developing information triage and dissemination activities, and providing additional services not offered by the public health service. The main methods of communicating with members were electronic mail, open meetings and forums. Most patient organizations considered health professionals to be the most important group of stakeholders. The sources of funding most frequently quoted were membership fees, public grants and contributions from the pharmaceutical industry. The most important factor for enhancing patient co-responsibility was considered to be involving patients in health care as a way to improve the quality of the heath services. The proposed future scenario that received the most support was the creation of a legal forum in which the patient's voice could be heard and demonstrably taken into account. Patient organizations can play an important role in providing patients and health professionals with information, promoting self care and improving the effectiveness of health care. These features require visible commitment by the health authorities to facilitate opportunities for patient decisions and choice within the system.

  16. Computerizing the Accounting Curriculum.

    ERIC Educational Resources Information Center

    Nash, John F.; England, Thomas G.

    1986-01-01

    Discusses the use of computers in college accounting courses. Argues that the success of new efforts in using computers in teaching accounting is dependent upon increasing instructors' computer skills, and choosing appropriate hardware and software, including commercially available business software packages. (TW)

  17. The Choreography of Accountability

    ERIC Educational Resources Information Center

    Webb, P. Taylor

    2006-01-01

    The prevailing performance discourse in education claims school improvements can be achieved through transparent accountability procedures. The article identifies how teachers generate performances of their work in order to satisfy accountability demands. By identifying sources of teachers' knowledge that produce choreographed performances, I…

  18. Model Accounting Program. Adopters Guide.

    ERIC Educational Resources Information Center

    Beaverton School District 48, OR.

    The accounting cluster demonstration project conducted at Aloha High School in the Beaverton, Oregon, school district developed a model curriculum for high school accounting. The curriculum is based on interviews with professionals in the accounting field and emphasizes the use of computers. It is suitable for use with special needs students as…

  19. California School Accounting Manual. 1984 Edition.

    ERIC Educational Resources Information Center

    Lundin, Janet, Ed.

    California's official school accounting procedures, amended in 1984 to clarify definitions and improve program cost accounting, are presented. Following an introduction that discusses general characteristics of school accounting, the manual explains the following areas of accounting practice: (1) financial reporting; (2) income; (3) expenditures;…

  20. 7 CFR 1770.12 - Supplementary accounts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... AGRICULTURE (CONTINUED) ACCOUNTING REQUIREMENTS FOR RUS TELECOMMUNICATIONS BORROWERS Uniform System of... shall be changed to conform with the State's accounting system. (b) In addition to the accounts set... Uniform System of Accounts. In those instances in which a State regulatory body having jurisdiction over...